Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes around the world: implications for public health

Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, UK.
International Journal of Epidemiology (Impact Factor: 9.18). 04/2009; 38(3):791-813. DOI: 10.1093/ije/dyp139
Source: PubMed


High levels of dietary sodium (consumed as common salt, sodium chloride) are associated with raised blood pressure and adverse cardiovascular health. Despite this, public health efforts to reduce sodium consumption remain limited to a few countries. Comprehensive, contemporaneous sodium intake data from around the world are needed to inform national/international public health initiatives to reduce sodium consumption.
Use of standardized 24-h sodium excretion estimates for adults from the international INTERSALT (1985-87) and INTERMAP (1996-99) studies, and recent dietary and urinary sodium data from observational or interventional studies--identified by a comprehensive search of peer-reviewed and 'grey' literature--presented separately for adults and children. Review of methods for the estimation of sodium intake/excretion. Main food sources of sodium are presented for several Asian, European and Northern American countries, including previously unpublished INTERMAP data.
Sodium intakes around the world are well in excess of physiological need (i.e. 10-20 mmol/day). Most adult populations have mean sodium intakes >100 mmol/day, and for many (particularly the Asian countries) mean intakes are >200 mmol/day. Possible exceptions include estimates from Cameroon, Ghana, Samoa, Spain, Taiwan, Tanzania, Uganda and Venezuela, though methodologies were sub-optimal and samples were not nationally representative. Sodium intakes were commonly >100 mmol/day in children over 5 years old, and increased with age. In European and Northern American countries, sodium intake is dominated by sodium added in manufactured foods ( approximately 75% of intake). Cereals and baked goods were the single largest contributor to dietary sodium intake in UK and US adults. In Japan and China, salt added at home (in cooking and at the table) and soy sauce were the largest sources.
Unfavourably high sodium intakes remain prevalent around the world. Sources of dietary sodium vary largely worldwide. If policies for salt reduction at the population level are to be effective, policy development and implementation needs to target the main source of dietary sodium in the various populations.

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    • "The real culprit however is sodium, whose impact on hypertension has been thoroughly studied, and reducing sodium in one's diet is known to lower the chances of hypertension (Dickinson et al., 2007; Havas et al., 2007; He and MacGregor, 2009; Karppanen and Mervaala, 2006). Natural sodium levels in foods account for about 10% of dietary intake, whereas processed foods and foods in restaurants are estimated to contribute over 75–90% of dietary sodium (Brown et al., 2009; Garriguet, 2007; Jacobson et al., 2013; U.S. Department of Agriculture, 2010). Health organizations world-wide have called for a lowering of sodium in foods (World action on salt and health; World Health Organization, 2006) and several countries, including Japan, Finland, Australia, U.K, USA and Canada have developed strategies for reducing sodium intake (Health Canada, 2010; World Action on Salt and Health). "
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    ABSTRACT: National and international health agencies have recommended a significant reduction in daily intake of sodium by reducing the amount of NaCl in foods, specifically processed meats. However, sodium reduction could increase the risk of survival and growth of spoilage and pathogenic microorganisms on these products. Therefore, alternate processing technologies to improve safety of sodium reduced foods are necessary. This study examined the effects of three different salt types and concentrations on high-pressure inactivation of Listeria monocytogenes in pre-blended ground chicken formulations. Ground chicken formulated with three salt types (NaCl, KCl, CaCl2), at three concentrations (0, 1.5, 2.5%) and inoculated with a four strain cocktail of L. monocytogenes (10(8)CFUg(-1)) were subjected to four pressure treatments (0, 100, 300, 600MPa) and two durations (60, 180s) in an experiment with factorial design. Surviving cells were enumerated by plating on Oxford agar and analysed by factorial ANOVA. Pressure treatments at 100 or 300MPa did not significantly (P=0.19-050) reduce L. monocytogenes populations. Neither salt type nor concentration had a significant effect on L. monocytogenes populations at these pressure levels. At 600MPa, salt types, concentrations and duration of pressure treatment all had a significant effect on L. monocytogenes populations. Formulations with increasing concentrations of NaCl or KCl showed significantly lower reduction in L. monocytogenes, while increase in CaCl2 concentration resulted in a significantly higher L. monocytogenes reduction. For instance, increase in NaCl concentration from 0 to 1.5 or 2.5% resulted in a log reduction of 6.16, 2.49 and 1.29, respectively, when exposed to 600MPa for 60s. In the case of CaCl2, increase from 0 to 1.5 or 2.5% resulted in a log reduction of 6.16, 7.28 and 7.47, respectively. These results demonstrate that high-pressure processing is a viable process to improve microbial safety of sodium reduced poultry products.
    International Journal of Food Microbiology 11/2015; DOI:10.1016/j.ijfoodmicro.2015.11.010 · 3.08 Impact Factor
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    • "Considering that many fast foods have high levels of dietary sodium, the effects of sodium consumption on health has garnered particular interest by scientific and clinical researchers (Powles et al., 2013). According to one report, the sodium content in fast foods was 100-fold higher than comparable foods prepared at home (Brown et al., 2009). Further, this study showed that the average consumption of dietary sodium was twofold higher in Asian countries compared to Western countries. "

    09/2015; 21(3):131-134. DOI:10.15616/BSL.2015.21.3.131
    • "Although there has been recent controversy about the potential health consequences of salt reduction (Alderman and Cohen, 2012; Institute of Medicine, 2013), the majority of research demonstrates that reducing salt intake at the population level will have a significant public health impact (Whelton et al., 2012; Appel et al., 2011). Salt reduction has been shown to be a cost-effective way to reduce cardiovascular disease (Brown et al., 2009; Mason et al., 2014; Cobiac et al., 2010; Barton et al., 2011; Wang and Labarthe, 2011) and is considered a ''best buy'' for reducing the burden of non-communicable diseases ( "
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    ABSTRACT: Eighty percent of non-communicable diseases (NCDs) occur in low- and middle-income countries (LMICs). In the Global Action Plan to prevent and control NCDs, the World Health Organization has set a target to reduce mean population salt intakes by 30% by 2025. To achieve this target, salt levels in prepared and processed foods must be reduced. In this paper we propose a step-wise approach for setting targets for salt levels in foods for LMICs, as the basis for voluntary or mandatory policy interventions. The five steps are: (1) identifying the foods which contribute to salt in the diet; (2) agreeing which foods to set targets for; (3) establishing the target levels; (4) stakeholder engagement; (5) establishing monitoring mechanisms. A case study of the process of establishing regional targets in the Pacific Islands is also provided. LMICs with limited resources should establish maximum upper limits for salt for the product categories, which together contribute the majority of salt in the diet. Targets should be standardized (e.g., salt per 100. g of product) and have clear timelines. As well as being the basis for voluntary or mandatory levels for salt levels in foods, targets can also be used to inform labeling and taxation policy. In order to have the most significant effect on population salt intake in LMICs, these policy interventions will need to be combined with consumer-facing strategies aimed at changing behaviours and investment in research and development to support effective implementation.
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