Global salt review may offer reduction ‘framework’

By Nathan Gray

- Last updated on GMT

Learning from current salt reduction strategies may help to produce a better framework for developing future initiatives, according to a global review of current methods.

The new review, published in the Journal of Hypertension​, identifies key characteristics from a number of salt reduction initiatives, including the need for industry involvement and central organisation. The authors, led by Jacqui Webster from the George Institute for Global Health, at the University of Sydney, Australia, said that the findings of the review will help to establish “a framework for guiding the future development of programmes.”

“Both mandatory and voluntary programmes appear to have potential provided that there are clear mechanisms for monitoring and penalties for noncompliance,”​ wrote Webster and her team.

They noted that that the UK “provides a good example of how voluntary programmes can function,” ​whilst​claiming that good examples of ‘effective legislation’ are those for bread in Portugal, “and the requirement for high salt warnings on salty foods in Finland.”

Salt reduction

Excessive intake of dietary sodium is strongly linked to hypertension, a risk factor for the development of cardiovascular disease and stroke. Whilst there is also evidence suggesting that high sodium intake is linked to gastric cancer, decreased bone density, and higher rates of obesity.

In recent years, these health concerns have led to a industry investing heavily in salt reduction strategies.

“It is now widely accepted that reducing salt consumption will lead to lower blood pressure levels resulting in significant health benefits, and centrally implemented national salt reduction strategies are projected to be highly cost-effective in the prevention of non-communicable diseases,”​ said Webster and her colleagues.

They said that as evidence of the impact and cost-effectiveness of salt reduction schemes grows, “it is increasingly important that policy makers have guidance about optimal programme design.”

The new research provides an overview of salt reduction initiatives from around the world, describing the core characteristics of each strategy to develop a framework for future initiatives.

Global overview

The authors identified 32 salt reduction initiatives globally, 19 in Europe, six in the Americas and seven in the Western Pacific Region. There were no salt reduction strategies identified in Africa.

Webster and co-workers noted that most strategies “are led by government organizations, involve industry-led food reformulation of food, have clear daily intake targets, and have strong communication strategies designed to change consumer behaviour.”​ They added that advocacy organizations have also played a key role in some reduction initiatives, most notably in the UK (CASH) and Australia (AWASH).

Many initiatives have industry reformulation of processed and catered foods at the core of their salt reduction efforts, said Webster and colleagues.

The reviewers noted that of the 32 schemes identified, 28 involved working with the food industry to reduce salt in foods, whilst 10 had front-of-pack labelling schemes.

Webster and co-workers said that with processed and catered foods contributing to between 75 and 80 per cent of salt in the diet in developed countries, targets to reduce sodium levels in these foods represents a key component of any reduction strategy.

However, the authors said that providing low salt alternates, without category-wide reductions in salt content “is not acceptable since such products are typically very different in taste, will not be purchased by consumers and will be rapidly discontinued by manufacturers and retailers.”

Source: Journal of Hypertension
Volume 29, Issue 6, Pages 1043–1050, doi: 10.1097/HJH.0b013e328345ed83
“Salt reduction initiatives around the world”
Authors” J.L Webster, E.K Dunford, C Hawkes, B.C Neal

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