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

ABSTRACT 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food sources of sodium are presented for several Asian, European and Northern American countries, including previously unpublished INTERMAP data.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.

128 Reads
  • Source
    • "This adapted version was pilot-tested with 603 individuals to ensure age-appropriateness. In Phase 2, some food items were included and the score of each item was revised according to the latest scientific evidence (Anderson et al. 2009; Brown et al. 2009; de Sa and Lock 2008; He and MacGregor 2009; Hoffmann et al. 2003; Kipping, Jago, and Lawlor 2008; Kushi et al. 2006; Mirmiran et al. 2009; Ruxton, Gardner, and McNulty 2010). Results of the 603 Phase 1 questionnaires were analyzed regarding item difficulty, and the questionnaire was changed in accordance. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This article describes the adaptation of the adult Portuguese version of the General Nutrition Knowledge Questionnaire (GNKQ) for adolescents, and its validation. Respondents were 1,315 adolescents, who completed the questionnaire in two phases. A subsample of 73 adolescents was used to measure test–retest reliability. Concurrent validity was tested using a sample of 32 dietetic students. The adapted version showed high internal consistency (Cronbach’s alpha = 0.92), test–retest reliability (R = 0.71) and concurrent validity (U = 22766.0; p Keywords: adolescents; nutrition knowledge; questionnaire; validation Document Type: Research Article DOI: Affiliations: 1: CIAFEL – Research Center in Physical Activity, Health and Leisure, Faculty of Sports, University of Porto, Portugal 2: CIAFEL – Research Center in Physical Activity, Health and Leisure, Department of Sports, University of Porto, Porto, Portugal 3: CIAFEL – Research Center in Physical Activity, Health and Leisure, Faculty of Sports, University of Porto, Porto, Portugal Publication date: September 3, 2014 More about this publication? Information for Authors Subscribe to this Title ingentaconnect is not responsible for the content or availability of external websites $(document).ready(function() { var shortdescription = $(".originaldescription").text().replace(/\\&/g, '&').replace(/\\, '<').replace(/\\>/g, '>').replace(/\\t/g, ' ').replace(/\\n/g, ''); if (shortdescription.length > 350){ shortdescription = "" + shortdescription.substring(0,250) + "... more"; } $(".descriptionitem").prepend(shortdescription); $(".shortdescription a").click(function() { $(".shortdescription").hide(); $(".originaldescription").slideDown(); return false; }); }); Related content In this: publication By this: publisher In this Subject: Nutrition & Food By this author: Ferro-Lebres ; Moreira ; Ribeiro GA_googleFillSlot("Horizontal_banner_bottom");
    Ecology of Food and Nutrition 09/2014; 53(5). DOI:10.1080/03670244.2013.873424 · 0.81 Impact Factor
  • Source
    • "The amount of dietary salt consumed is an important determinant of blood pressure levels and a modest reduction in salt has been found to have a significant and, from a population perspective, important effect on lowering blood pressure [2-5]. It has been estimated that decreasing population-level salt intake from the estimated global levels of 9-12 g/d [6] to the recommended level of 5 g/d [7] would result in significant reduction of blood pressure and would reduce the world wide stroke rate and cardiovascular disease rate by 23% and 17%, respectively [8,9]. Achieving this reduction would project to prevent 2.5 million deaths worldwide each year [8,9]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Evidence from numerous studies suggests that salt intake is an important determinant of elevated blood pressure. Robust data about salt consumption among adults in Bangladesh is sparse. However, much evidence suggests saline intrusion due to sea level rise as a result of climate change exposes more than 20 million people to adverse effects of salinity through the food and water supply. The objective of our study was to assess salt consumption among adults in a coastal region of Bangladesh. Methods Our study was cross sectional and conducted during October-November 2011. A single 24 hour urine was collected from 400 randomly selected individuals over 18 years of age from Chakaria, a rural, coastal area in Southeastern Bangladesh. Logistic regression was conducted to identify the determinants of high salt consumption. Results The mean urinary sodium excretion was 115 mmol/d (6.8 g salt). Based on logistic regression using two different cutoff points (IOM and WHO), housewives and those living in the coastal area had a significantly higher probability of high salt intake compared with people who were engaged in labour-intensive occupations and who lived in hilly areas. Conclusion It is important to create awareness about the implication of excessive salt intake on health and to develop strategies for reducing salt intake that can be implemented at the community-level. A sustainable policy for salt reduction in the Bangladeshi diet should be formulated with special emphasis on coastal areas.
    BMC Public Health 06/2014; 14(584). DOI:10.1186/1471-2458-14-584 · 2.26 Impact Factor
  • Source
    • "In addition to eliciting salty taste (McCaughey & Scott, 1998), sodium chloride can suppress bitterness (Frijters & Schifferstein, 1994; Keast & Breslin, 2002), increase sweetness at low concentrations (Keast & Breslin, 2003) and enhance the perception of volatile flavour compounds (Ventanas, Puolanne, & Tuorila, 2010). However, dietary salt intakes are much higher than nutritional requirements in most countries (Brown, Tzoulaki, Candeias, & Elliott, 2009). There is strong evidence for a link between high dietary sodium and hypertension; thereby increasing the risk of cardiovascular disease (Cook et al., 2007; Strazzullo, D'Elia, Kandala, & Cappuccio, 2009; Tuomilehto et al., 2001). "
    [Show abstract] [Hide abstract]
    ABSTRACT: There is strong evidence for the link between high dietary sodium and increased risk of cardiovascular disease which drives the need to reduce salt content in foods. In this study, herb and spice blends were used to enhance consumer acceptability of a low salt tomato soup (0.26% w/w). Subjects (n=148) scored their liking of tomato soup samples over five consecutive days. The first and last days were pre-and post-exposure visits where all participants rated three tomato soup samples; standard, low salt and low salt with added herbs and spices. The middle 3 days were the repeated exposure phase where participants were divided into three balanced groups; consuming the standard soup, the low salt soup, or the low salt soup with added herbs and spices. Reducing salt in the tomato soup led to a significant decline in consumer acceptability, and incorporating herbs and spices did not lead to an immediate enhancement in liking. However, inclusion of herbs and spices enhanced the perception of the salty taste of the low salt soup to the same level as the standard. Repeated exposure to the herbs and spice-modified soup led to a significant increase in the overall liking and liking of flavour, texture and aftertaste of the soup, whereas no changes in liking were observed for the standard and low salt tomato soups over repeated exposure. Moreover, a positive trend in increasing the post-exposure liking of the herbs and spices soup was observed. The findings suggest that the use of herbs and spices is a useful approach to reduce salt content in foods; however, herbs and spices should be chosen carefully to complement the food as large contrasts in flavour can polarise consumer liking.
    Appetite 05/2014; 81. DOI:10.1016/j.appet.2014.05.029 · 2.69 Impact Factor
Show more


128 Reads
Available from