Abstract
Many studies suggest that high salt intakes are related to high blood pressure and consequently cardiovascular diseases. In addition salt intake was found to be related with obesity, renal stones, osteoporosis and stomach cancer. Belgium, such as other European countries, is suffering from both salt intakes that are twice as high as the recommended intakes and mild iodine deficiency. No comprehensive strategy encompassing both public health problems has been developed. While specific salt reduction targets for processed foods are still under discussion using a consensus approach with industry, an agreement was signed between the bakery sector and the Ministry of Health in April 2009, to encourage and increase the use of iodised salt in the production of bread. Based on results of recent surveys on population iodine status it is advised not to currently revise iodine concentrations in salt in bread but to advocate for a higher percentage of bakers using iodised salt and to install a good monitoring system to control the percentage of bakers effectively using adequately iodised salt. With regard to salt reduction, it is of utmost importance that all companies contribute and harmonise the salt content of their products according to the lowest possible thresholds in a first step. In order to achieve this goal, it will be necessary, in addition to the consensus approach, to come up with at least some legislative tools such as a salt tax or mandatory labelling of foods exceeding a specific sodium concentration. Once salt reduction targets have been clearly defined in Belgium over the longer term, a legal framework should be set in place where iodine concentration in salt for the production of bread and household salt is strictly regulated by law, to avoid a large variability in the iodine content of salt brands consumed. In conclusion, it is possible to tackle salt reduction and iodine deficiency at the same time on the condition that the approach is coordinated and well monitored. All the interventions and measures taken should clearly include education and communication directed towards consumers, food producers, public health professionals, pharmacists, healthcare workers, and media representatives.
Highlights
Background there is still controversy about the impact of sodium reduction on health or the benefits of universal salt reduction [1,2,3], it has been estimated on the basis of results of a meta-analysis of randomised controlled trials that a decrease of habitual salt intake with 6 g a day would result in reductions in systolic/diastolic blood pressure of 7/4 mmHg in people with hypertension and 4/2 mm Hg in those without hypertension
Belgium, such as other European countries, is suffering from salt intakes [16,17] that are much higher than the recommended intake level of less than 5 g/day [7] or the level of 3 g/day recommended for optimal health benefit [6]
A national survey on iodine status in Belgian school-aged children initiated 17 months after the start of the fortification showed a median urinary iodine concentration (UIC) of 113.1 μg/L, compared with 84.8 μg/L among their mothers [24]. These results indicated iodine sufficiency among children and suggested that the voluntary salt in bread iodisation program may have contributed to the optimization of iodine intake in school-aged children, as in 1998 median UIC among school-aged children was only 80 μg/L [18]
Summary
These examples show that while salt reduction initiatives can be very successful, it is very difficult to reach the recommended salt intake level of less than 5 g per day at population level and it may take a tremendous amount of time to achieve this Belgium, such as other European countries, is suffering from salt intakes [16,17] that are much higher than the recommended intake level of less than 5 g/day [7] or the level of 3 g/day recommended for optimal health benefit [6]. Both optimizing iodine intake and reducing sodium intake were set as priorities in the National Nutrition and Health Plan of the Belgian Ministry of Health 2005–2010 but no comprehensive strategy encompassing both public health problems has been developed until now
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