Salt Reduction Targets Research Articles

Assault on salt Intake

Assault on salt Intake

Changes in the salt content of packaged foods sold in supermarkets between 2015-2020 in the United Kingdom: A repeated cross-sectional study.

Excess consumption of salt is linked to an increased risk of hypertension and cardiovascular disease. The United Kingdom has had a comprehensive salt reduction programme since 2003, setting a series of progressively lower, product-specific reformulation targets for the food industry, combined with advice to consumers to reduce salt. The aim of this study was to assess the changes in the sales-weighted mean salt content of grocery foods sold through retail between 2015 and 2020 by category and company. Information for products, including salt content (g/100 g), was collected online from retailer websites for 6 consecutive years (2015 to 2020) and was matched with brand-level retail sales data from Euromonitor for 395 brands. The sales-weighted mean salt content and total volume of salt sold were calculated by category and company. The mean salt content of included foods fell by 0.05 g/100 g, from 1.04 g/100 g in 2015 to 0.90 g/100 g in 2020, equivalent to -4.2% (p = 0.13). The categories with the highest salt content in 2020 were savoury snacks (1.6 g/100 g) and cheese (1.6 g/100 g), and the categories that saw the greatest reductions in mean salt content over time were breakfast cereals (-16.0%, p = 0.65); processed beans, potatoes, and vegetables (-10.6%, p = 0.11); and meat, seafood, and alternatives (-9.2%, p = 0.56). The total volume of salt sold fell from 2.41 g per person per day to 2.25 g per person per day, a reduction of 0.16 g or 6.7% (p = 0.54). The majority (63%) of this decrease was attributable to changes in mean salt content, with the remaining 37% accounted for by reductions in sales. Across the top 5 companies in each of 9 categories, the volume of salt sold decreased in 26 and increased in 19 cases. This study is limited by its exclusion of foods purchased out of the home, including at restaurants, cafes, and takeaways. It also does not include salt added at the table, or that naturally occurring in foods, meaning the findings underrepresent the population's total salt intake. The assumption was also made that the products matched with the sales data were entirely representative of the brand, which may not be the case if products are sold exclusively in convenience stores or markets, which are not included in this database. There has been a small decline in the salt content of foods and total volume of salt sold between 2015 and 2020, but observed changes were not statistically significant so could be due to random variations over time. We suggest that mandatory reporting of salt sales by large food companies would increase the transparency of how individual businesses are progressing towards the salt reduction targets.

Reduction of Cardiovascular Events and Related Healthcare Expenditures through Achieving Population-Level Targets of Dietary Salt Intake in Japan: A Simulation Model Based on the National Health and Nutrition Survey.

Reducing population dietary salt intake is expected to help prevent cardiovascular disease and thus constrain increasing national healthcare expenditures in Japan’s super-aged society. We aimed to estimate the impact of achieving global and national salt-reduction targets (8, <6, and <5 grams/day) on cardiovascular events and national healthcare spending in Japan. Using published data including mean salt intake and systolic blood pressure from the 2019 National Health and Nutrition Survey, we developed a Markov model of a closed cohort of adults aged 40–79 years in 2019 (n = 66,955,000) transitioning among six health states based on the disease course of ischemic heart disease (IHD) and stroke. If mean salt intake were to remain at 2019 levels over 10 years, cumulative incident cases in the cohort would be approximately 2.0 million for IHD and 2.6 million for stroke, costing USD 61.6 billion for IHD and USD 104.6 billion for stroke. Compared with the status quo, reducing mean salt intake towards the targets over 10 years would avert 1–3% of IHD and stroke events and save up to 2% of related national healthcare costs. Attaining dietary salt-reduction goals among adults would yield moderate health economic benefits in Japan.

New wave of flavours – On new ways of developing and processing seaweed flavours

Seaweeds have a naturally salty taste owing to their high content of minerals like potassium, besides sodium, which can be utilised as a healthy sodium replacer in food. In addition, some seaweeds contain a range of potential flavour components which can be released by mild processing and used to naturally enhance the flavour of food. In the present study, flavour ingredients from brown seaweed to use as a food component were developed. The work included enzymatic processing, by subsequently applying an alginase (Alg3) and Umamizyme to freeze dried and milled Ascophyllum nodosum and Saccharina latissima seaweed biomass. The chemical composition was determined by means of monosaccharide, polyphenol, and sodium content. Flavour profiles of the produced flavour extracts were evaluated by e-tongue and a cell assay, as well as by sensory panellists. The seaweed extracts were incorporated into food models and their sodium replacing and flavour enhancing properties were objectively evaluated by trained sensory panellists. The aim was to offer innovative processing solutions and new healthy flavour ingredients to meet salt reduction targets and flavour enhancing properties using seaweed. The results obtained flavour ingredients that are richer in umami and salty taste with the potential to replace sodium and create flavour enhancing ingredients for certain food products.

Progress in Iodine Deficiency Disorders (IDD) Control and Elimination in Europe and Central Asia Region (ECAR) in 2010–2020

Salt iodization in Europe and Central Asia Region (ECAR) c ountries has a long history. Universal salt iodization (USI) strategies were reintroduced in ECAR countries in the mid-1990s and gained strong momentum during the 2000–2009 decade: by the end of 2009, access to adequately iodized salt by the population in ECAR had risen to 55% — a quantum leap improvement compared to a previous decade but still short of the operational target of 90%. The objective of this review was to document the USI achievements and challenges in the 18 ECAR countries during the decade of 2010-2020 and developed recommendations for actions to maintain the USI. The review was conducted by analysis of information obtained from a variety of sources, including communication with UNICEF country offices, IGN National Coordinators as well as online resources and publications available publicly. Based on available information, countries of the ECAR fall into 3 groups. Group 1. USI at scale: 11 countries (Armenia, Azerbaijan, Bosnia and Herzegovina, Kosovo, North Macedonia, Montenegro, Serbia, Turkmenistan, Kazakhstan, Kyrgyzstan and Georgia) successfully sustained the adequate iodine status achieved earlier. This group should focus on USI maintenance ensuring that the USI target of uninterrupted universal use of iodized salt in households and food/bakery industry is included into relevant national programs, along with the salt reduction targets. Group 2. USI at scale but risk of slippage: 3 countries (Albania, Moldova and Kyrgyzstan) sustained the adequate iodine status of population but their household use of adequately iodized salt remains low and the use of iodized salt in processed foods — patchy, with weak regulatory monitoring and enforcement systems in place putting sustainability at risk. Recommendations for these countries are to secure strong regulatory monitoring and enforcement of the national iodized salt standards to ensure consistent and high (&gt;90%) use of iodized salt at household level as well as in production in key salt-containing industrially processed staple foods (especially, bread). Group 3. USI — more efforts needed: in 4 countries (Russia, Tajikistan, Ukraine and Uzbekistan), the population and, specifically, most vulnerable groups continued to suffer from inadequate iodine status. This group of countries will need to enhance and expand their existing USI effort by better engaging with salt producers and private sector and identifying resources for improved regulatory monitoring. Adoption of USI legislation is paramount to reaching high iodized salt coverage and optimum iodine nutrition in Russia and Ukraine. The data and information in the present review confirm that USI strategy is successfully sustained in the majority of countries in the ECAR. The experiences in this region add to the growing evidence that USI is effective in alleviating iodine deficiency in the population and support the view that global success can be achieved by ensuring that food-grade salt iodization becomes the norm in the salt industry and society.

Health Impact and Cost-Effectiveness of Achieving the National Salt and Sugar Reduction Initiative Voluntary Sugar Reduction Targets in the United States: A Microsimulation Study.

High intake of added sugar is linked to weight gain and cardiometabolic risk. In 2018, the US National Salt and Sugar Reduction Initiative proposed government-supported voluntary national sugar reduction targets. This intervention's potential effects and cost-effectiveness are unclear. A validated microsimulation model, CVD-PREDICT (Cardiovascular Disease Policy Model for Risk, Events, Detection, Interventions, Costs, and Trends), coded in C++, was used to estimate incremental changes in type 2 diabetes, cardiovascular disease (CVD), quality-adjusted life-years (QALYs), costs, and cost-effectiveness of the US National Salt and Sugar Reduction Initiative policy. The model was run at the individual level, incorporating the annual probability of each person's transition between health statuses on the basis of risk factors. The model incorporated national demographic and dietary data from the National Health and Nutrition Examination Survey across 3 cycles (2011 through 2016), added sugar-related diseases from meta-analyses, and policy costs and health-related costs from established sources. A simulated nationally representative US population was created and followed until age 100 years or death, with 2019 as the year of intervention start. Findings were evaluated over 10 years and a lifetime from health care and societal perspectives. Uncertainty was evaluated in a 1-way analysis by assuming 50% industry compliance and probabilistic sensitivity analyses through a second-order Monte Carlo approach. Model outputs included averted diabetes cases, CVD events and CVD deaths, QALYs gained, and formal health care cost savings, stratified by age, race, income, and education. Achieving the US National Salt and Sugar Reduction Initiative sugar reduction targets could prevent 2.48 million CVD events, 0.49 million CVD deaths, and 0.75 million diabetes cases; gain 6.67 million QALYs; and save $160.88 billion net costs from a societal perspective over a lifetime. The policy became cost-effective (<150 000/QALYs) at 6 years, highly cost-effective (<50 000/QALYs) at 7 years, and cost-saving at 9 years. Results were robust from a health care perspective, with lower (50%) industry compliance, and in probabilistic sensitivity analyses. The policy could also reduce disparities, with greatest estimated health gains per million adults among Black or Hispanic individuals, lower income, and less educated Americans. Implementing and achieving the US National Salt and Sugar Reduction Initiative sugar reformation targets could generate substantial health gains, equity gains, and cost savings.

Dietary Salt Reduction, Prevalence of Hypertension and Avoidable Burden of Stroke in Vietnam: Modelling the Health and Economic Impacts.

Dietary salt reduction has been recommended as a cost-effective population-wide strategy to prevent cardiovascular disease. The health and economic impact of salt consumption on the future burden of stroke in Vietnam is not known.Objective: To estimate the avoidable incidence of and deaths from stroke, as well as the healthy life years and healthcare costs that could be gained from reducing salt consumption in Vietnam.Methods: This was a macrosimulation health and economic impact assessment study. Data on blood pressure, salt consumption and stroke epidemiology were obtained from the Vietnam 2015 STEPS survey and the Global Burden of Disease study. A proportional multi-cohort multistate lifetable Markov model was used to estimate the impact of achieving the Vietnam national salt targets of 8 g/day by 2025 and 7 g/day by 2030, and to the 5 g/day WHO recommendation by 2030. Probabilistic sensitivity analysis was conducted to quantify the uncertainty in our projections.Results: If the 8 g/day, 7 g/day, and 5 g/day targets were achieved, the prevalence of hypertension could reduce by 1.2% (95% uncertainty interval [UI]: 0.5 to 2.3), 2.0% (95% UI: 0.8 to 3.6), and 3.5% (95% UI: 1.5 to 6.3), respectively. This would translate, respectively, to over 80,000, 180,000, and 257,000 incident strokes and over 18,000, 55,000, and 73,000 stroke deaths averted. By 2025, over 56,554 stroke-related health-adjusted life years (HALYs) could be gained while saving over US$ 42.6 million in stroke healthcare costs. By 2030, about 206,030 HALYs (for 7 g/day target) and 262,170 HALYs (for 5 g/day target) could be gained while saving over US$ 88.1 million and US$ 122.3 million in stroke healthcare costs respectively.Conclusion: Achieving the national salt reduction targets could result in substantial population health and economic benefits. Estimated gains were larger if the WHO salt targets were attained and if changes can be sustained over the longer term. Future work should consider the equity impacts of specific salt reduction programs.

Estimating Usual Sodium Intake and Sodium-to-Potassium Molar Ratios From Urine Excretion Among Canadian Adults: An Analysis of the Canadian Health Measures Survey

ObjectivesHigh dietary sodium is now well established to be a major risk factor for hypertension, cardiovascular disease and mortality. Monitoring population sodium intakes is critical for evaluating progress towards Health Canada’s dietary salt reduction targets. Given that approximately 90% of ingested sodium is excreted in the urine, accurate estimations of average daily urinary sodium is critical for determining population sodium intake. However, until recently, nationally representative surveys from Canada have only collected a single “spot” (casual) urine sample which are prone to bias due to large day-to-day variation amongst individuals. The aim of this study was to estimate average population sodium intake using the latest version of the Canadian Heath Measures Survey, Cycle 5 (2016–2017) which, for the first time includes 2 non-consecutive days of spot urine samples from a representative sample of the Canadian population. MethodsThe INTERSALT equations, validated for western populations, was used to estimate 24hr intakes of sodium amongst adults ≥19 years of age, excluding pregnant women (n = 3032). Individual sodium-to-potassium molar ratios (Na: K) were also calculated, given their importance in predicting hypertension risk. The second day of spot urines was used to control for within-person variation in both sodium excretion and NA: K molar ratios, using the National Cancer Institute method for estimating usual dietary intake, adjusting for respondents’ fasting status. ResultsMean sodium excretion was 3142 ± 30 mg/day and 3154 ± 30 mg/dayin men and women, respectively. In both men and women only 14% of participants consumed less than the recommended 2300 mg of sodium/day. The Na: K was approximately 1.4 in both men and women with only 15–20%, at or below, an optimal Na: K of 1. ConclusionsThis is the first study from Canada to estimate sodium and NA: K at the population level, using two days of spot urine samples, providing robust baseline data for continued monitoring. Our findings reveal a need for ongoing efforts to reduce population sodium and improve potassium intakes in order to reduce cardiovascular risk. Funding SourcesCanadian Institutes of Health Research.

The role of bread in the UK diet: An update

AbstractBread has been a widely consumed traditional staple food in the UK for centuries, although there has been a decrease in consumption over the past 50 years. This may reflect the increased availability and popularity of other starchy foods such as pasta and rice and potentially negative misconceptions around bread and health (e.g. weight gain and gastrointestinal symptoms). On average, in the UK, bread provides 11–12% of energy, 16–20% of carbohydrate, 10–12% of protein and 17–21% of fibre intakes across all age groups and is a key contributor to micronutrient intakes (9–14% of folate, 15–17% of iron, 12–17% of calcium, 12–13% of magnesium and 10–11% of zinc). White bread is the largest contributor to salt intakes in the UK, though average salt content has been declining, largely as a result of the government reformulation programme with the food industry, including the setting of salt reduction targets. The mandatory fortification of flour with folic acid, a strategy used successfully in &gt;60 other countries as a means of reducing neural tube defects (NTDs), is currently being considered and may be an important public health initiative. The variety of fibre types in bread such as arabinoxylan, oligosaccharides and resistant starch, as well as other bioactives including polyphenols, are an area of emerging interest in relation to nutrition and health. This paper gives an overview of the current contribution of bread to nutrient intakes and considers trends which may change the role of bread in our diet going forward.

The potential for microwave technology and the ideal profile method to aid in salt reduction

This study was the first to evaluate the influence of the combination strategies of flavor addition and microwave-assisted thermal sterilization (MATS) processing for salt reduction implications. In freshly prepared mashed potatoes, a 30% and 50% salt reduction (w/w) in comparison to a 100% salt sample with three flavor variations (no additional flavor, garlic, and pepper) were investigated. Also, using the ideal profile method (IPM), the influence of MATS versus retort processing, in comparison to a freshly prepared sample, and flavor addition on mashed potato sensory properties and acceptance was investigated. Chemical characterization using the electronic tongue for nonvolatile compounds and headspace solid-phase microextraction (HS-SPME)/gas chromatography-mass spectrometry (GC-MS) for volatile analysis was completed. IPM revealed the ideal data were consistent at both the panel and consumer levels from a sensory and hedonic perspective. Results demonstrated the ideal mashed potato product would remain low in bitterness but have more intense pepper and potato aromas and flavors than the current samples evaluated. The salt level could be reduced by 50% while still maintaining flavor and overall acceptance in freshly prepared samples, but this was accompanied by a loss in saltiness intensity perception. The saltiness intensity was not different from the freshly prepared samples when processed via MATS but was different when processed by the retort. For chemical characterization, the electronic tongue showed a high discrimination index (>89%) and correlated highly (>0.8) with many sensory attributes. As salt concentration in the mashed potatoes decreased, the recovery of volatile compounds decreased. The present work contributes to the understanding of product reformulation for the purpose of salt reduction. PRACTICAL APPLICATION: Product developers need strategies to bring salt down to target levels while maintaining consumer acceptance. The combination strategies of flavor addition and MATS processing may allow for a new strategy to assist product developers in reaching salt reduction targets. Furthermore, developers should bear in mind that noticeable intensity differences may not alter the preference for the product. Thus, intensity differences that result in changes in acceptance should be the focus of quality insurance rather than utilizing just noticeable differences.

A survey of Chinese consumers' knowledge, beliefs and behavioural intentions regarding salt intake and salt reduction.

Globally, China is among the 'saltiest' nations. In order to support current nationwide salt reduction initiatives, we investigated Chinese consumers' knowledge, beliefs and behaviours related to salt intake and salt reduction. A cross-sectional face-to-face survey was carried out, focusing on salt knowledge, beliefs and behaviours related to salt intake and salt reduction, perceptions of salt reduction responsibility and support for different national strategies. The survey was carried out in China mainland. Consumers (n 2444) from six of seven major geographical regions in China participated in the survey. After data cleaning, a sample of 2430 was included in the final analysis. A majority of Chinese consumers believed that salt added during home cooking was the biggest contributor to their salt intake. Knowledge gaps existed in the awareness of salt hidden in certain foods and flavouring products. Chinese consumers in general were interested in lowering their salt intake. They were aware of salt reduction tools, but the adoption level was low. Consumers expressed strong support for promotion of salt-restriction spoons and public education, but not fiscal policies (e.g. salt-related tax or subsidies). In terms of individual differences, education status demonstrated a substantial impact on salt reduction knowledge and behaviour. There is still big room to 'shake' Chinese consumers' salt habit. The present study provides important evidence and consumer insights to support China's efforts to meet its salt reduction targets.

The Salt Content of Lunch Meals Eaten at Danish Worksites.

Monitoring levels of sodium (salt) in meals consumed out-of-home is needed to support effective implementation of salt-reduction strategies. The objective of the study was to examine lunch salt intake at 15 worksite canteens and to compare with results from a comparable study conducted 10 years before. A duplicate-portion-technique with subsequent chemical analysis was used to quantify 240 customers’ lunch salt intake. Estimated mean salt intake was 2.6 g/meal (95% Cl: 2.2 to 3.0 g/meal) and 0.78 g/100 g (95% Cl: 0.69 to 0.88 g/100 g). Salt intake measured both as g per meal and per 100 g was found to be significantly higher for male compared with female participants (+0.10 g/100 g, 95% Cl: +0.02 to +0.17 g/100 g, p = 0.011). Compared with the study conducted 10 years before, there was a significantly lower estimated salt intake of 0.5 g/meal (95% CI: −0.8 to −0.2 g/meal, p = 0.001), suggesting a possible reduction in canteen lunch salt intake during a 10-year period. Still, 40% of the meals exceeded the Nordic Keyhole label requirements of maximum 0.8 g salt per 100 g for ready meals. A further reduction of salt intake is warranted to comply with salt reduction targets.

Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji.

This paper reports the process evaluation and costing of a national salt reduction intervention in Fiji. The population-wide intervention included engaging food industry to reduce salt in foods, strategic health communication and a hospital program. The evaluation showed a 1.4 g/day drop in salt intake from the 11.7 g/day at baseline; however, this was not statistically significant. To better understand intervention implementation, we collated data to assess intervention fidelity, reach, context and costs. Government and management changes affected intervention implementation, meaning fidelity was relatively low. There was no active mechanism for ensuring food companies adhered to the voluntary salt reduction targets. Communication activities had wide reach but most activities were one-off, meaning the overall dose was low and impact on behavior limited. Intervention costs were moderate (FJD $277,410 or $0.31 per person) but the strategy relied on multi-sector action which was not fully operationalised. The cyclone also delayed monitoring and likely impacted the results. However, 73% of people surveyed had heard about the campaign and salt reduction policies have been mainstreamed into government programs. Longer-term monitoring of salt intake is planned through future surveys and lessons from this process evaluation will be used to inform future strategies in the Pacific Islands and globally.

The history of food reformulation

The history of food reformulation

South Africa's salt reduction strategy: Are we on track, and what lies ahead?

On 2 September 2016, 25 local and international participants from various sectors met in Cape Town to take stock of South Africa (SA)'s progress in salt reduction and develop a roadmap for action. SA is centre stage on salt reduction globally, being the first country to mandate salt reduction across a wide range of processed foods. Excessive salt intake contributed by processed foods and discretionary sources motivated SA to implement a public awareness campaign in parallel with legislation to reduce salt intake to the World Health Organization target of 5 g per day. Five priority areas were identified for continued action on salt reduction, including obtaining research funds for continued monitoring and compliance of salt reduction targets. Determining the contribution of foods eaten out of home to total salt intake and implementing strategies to address this sector were also highlighted as key actions. Lastly, implementing the next stage of the Salt Watch awareness campaign to change.

Modeling health gains and cost savings for ten dietary salt reduction targets.

BackgroundDietary salt reduction is included in the top five priority actions for non-communicable disease control internationally. We therefore aimed to identify health gain and cost impacts of achieving a national target for sodium reduction, along with component targets in different food groups.MethodsWe used an established dietary sodium intervention model to study 10 interventions to achieve sodium reduction targets. The 2011 New Zealand (NZ) adult population (2.3 million aged 35+ years) was simulated over the remainder of their lifetime in a Markov model with a 3 % discount rate.ResultsAchieving an overall 35 % reduction in dietary salt intake via implementation of mandatory maximum levels of sodium in packaged foods along with reduced sodium from fast foods/restaurant food and discretionary intake (the “full target”), was estimated to gain 235,000 QALYs over the lifetime of the cohort (95 % uncertainty interval [UI]: 176,000 to 298,000). For specific target components the range was from 122,000 QALYs gained (for the packaged foods target) down to the snack foods target (6100 QALYs; and representing a 34–48 % sodium reduction in such products).All ten target interventions studied were cost-saving, with the greatest costs saved for the mandatory “full target” at NZ$1260 million (US$820 million). There were relatively greater health gains per adult for men and for Māori (indigenous population).ConclusionsThis work provides modeling-level evidence that achieving dietary sodium reduction targets (including specific food category targets) could generate large health gains and cost savings for a national health sector. Demographic groups with the highest cardiovascular disease rates stand to gain most, assisting in reducing health inequalities between sex and ethnic groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s12937-016-0161-1) contains supplementary material, which is available to authorized users.

Salt reduction in Australia: from advocacy to action.

As part of its endorsement of the World Health Organization's Global Action Plan to prevent non-communicable diseases, the Federal Government of Australia has committed to a 30% reduction in average population salt intake by 2025. Currently, mean daily salt intake levels are 8-9 g, varying by sex, region and population group. A number of salt reduction initiatives have been established over the last decade, but key elements for a co-ordinated population-level strategy are still missing. The objective of this review is to provide a comprehensive overview of existing population-level salt reduction activities in Australia and identify opportunities for further action. A review of the published literature and stakeholder activities was undertaken to identify and document current activities. The activities were then assessed against a pre-defined framework for salt reduction strategies. A range of initiatives were identified from the review. The Australian Division of World Action on Salt and Health (AWASH) was established in 2005 and in 2007 launched its Drop the Salt! Campaign. This united non-governmental organisations (NGOs), health and medical and food industry organisations in a co-ordinated advocacy effort to encourage government to develop a national strategy to reduce salt. Subsequently, in 2010 the Federal Government launched its Food and Health Dialogue (FHD) with a remit to improve the health of the food supply in Australia through voluntary partnerships with food industry, government and non-government public health organisations. The focus of the FHD to date has been on voluntary reformulation of foods, primarily through salt reduction targets. More recently, in December 2014, the government's Health Star Rating system was launched. This front of pack labelling scheme uses stars to highlight the nutritional profile of packaged foods. Both government initiatives have clear targets or criteria for industry to meet, however, both are voluntary and the extent of industry uptake is not yet clear. There is also no parallel public awareness campaign to try and influence consumer behaviour relating to salt and no agreed mechanism for monitoring national changes in salt intake. The Victorian Health Promotion Foundation (VicHealth) has recently instigated a State-level partnership to advance action and will launch its strategy in 2015. In conclusion, salt reduction activities are currently being implemented through a variety of different programs but additional efforts and more robust national monitoring mechanisms are required to ensure that Australia is on track to achieve the proposed 30% reduction in salt intake within the next decade.

Progress on Salt Reduction in the Pacific Islands: From Strategies to Action

Most populations are consuming too much salt which is the main contributor of high blood pressure, a leading risk factor of cardiovascular disease and stroke. The South Pacific Office of the World Health Organization has been facilitating the development of salt reduction strategies in Pacific Island Countries and areas (PICs). The objective of this analysis was to review progress to date and identify regional actions needed to support PICs and ensure they achieve the global target to reduce population salt intake by 30% by 2025. Relevant available national food, health and non-communicable disease (NCD) plans from all 22 PICs were reviewed. NCD co-ordinators provided updates and relayed experiences through semi-structured interviews. All activities were systematically categorised according to an existing salt reduction framework for the development of salt reduction strategies. Salt reduction consultations had been held in 14 countries and final strategies or action plans developed in nine of these, with drafts available in a further three. Three other countries had integrated salt reduction into NCD strategic plans. Baseline monitoring of salt intake had been undertaken in three countries, salt levels in foods in nine countries and salt knowledge, attitude and behaviour surveys in four countries. Most countries were at early stages of implementation and identified limited resources as a barrier to action. Planned salt reduction strategies included work with food industry or importers, implementing regional salt reduction targets, reducing salt levels in school and hospital meals, behaviour change campaigns, and monitoring and evaluation. There had been good progress on salt reduction planning in PICs. The need for increased capacity to effectively implement agreed activities, supported by regional standards and the establishment of improved monitoring systems, were identified as important steps to ensure the potential cardiovascular health benefits of salt reduction could be fully realised in the region.

Cross-sectional survey of salt content in cheese: a major contributor to salt intake in the UK

ObjectiveTo investigate the salt (sodium chloride) content in cheese sold in UK supermarkets.Study designWe carried out a cross-sectional survey in 2012, including 612 cheeses available in UK supermarkets.MethodsThe salt content...

Sodium reduction and the correction of iodine intake in Belgium: Policy options

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.