Barriers for progress in salt reduction in the general population. An international study

Abstract

Salt reduction is important for reducing hypertension and the risk of cardiovascular events, nevertheless worldwide salt intakes are above recommendations. Consequently strategies to reduce intake are required, however these require an understanding of salt intake behaviours to be effective. As limited information is available on this, an international study was conducted to derive knowledge on salt intake and associated behaviours in the general population. An online cohort was recruited consisting of a representative sample from Germany, Austria, United States of America, Hungary, India, China, South Africa, and Brazil (n=6987; aged 18-65 years; age and gender stratified). Participants completed a comprehensive web-based questionnaire on salt intake and associated behaviours. While salt reduction was seen to be healthy and important, over one third of participants were not interested in salt reduction and the majority were unaware of recommendations. Salt intake was largely underestimated and people were unaware of the main dietary sources of salt. Participants saw themselves as mainly responsible for their salt intake, but also acknowledged the roles of others. Additionally, they wanted to learn more about why salt was bad for health and what the main sources in the diet were. As such, strategies to reduce salt intake must raise interest in engaging in salt reduction through improving understanding of intake levels and dietary sources of salt. Moreover, while some aspects of salt reduction can be globally implemented, local tailoring is required to match level of interest in salt reduction. These findings provide unique insights into issues surrounding salt reduction and should be used to develop effective salt reduction strategies and/or policies.

Perspectives of the public on reducing population salt intake in Ireland

“…We employed a previously developed 'responsibility for salt reduction' scale by Newson and colleagues (17) to assess how much responsibility participants felt different groups of stakeholders had for reducing salt intake in the population. Participants were asked to rate how much of the responsibility for reducing salt intake should lie with each of seven groups (see Table 3 for full list).…”

“…We assessed participants' interest in engaging in salt reduction by employing a measure developed by Newson and colleagues (17) that is based on the theoretical framework from the stages of change model (23) . Participants were asked to choose only the statement that best represented their current interest in reducing their salt intake (see Table 2 for full wording of these statements).…”

“…For example, beliefs regarding blame and responsibility for a public health issue have been found to be strong drivers of public acceptance (4,12) . In considering how attributions of responsibility may apply to the current investigation, previous research has shown that consumers believe that external stakeholders (namely, food manufacturers) need to take responsibility for reducing salt intake (5,17) ; however, it is not known whether and how this may influence their support for various salt reduction policies. How motivated an individual is to make healthier choices has also been shown to impact support for various health policies (13,18) .…”

Liking, salt taste perception and use of table salt when consuming reduced-salt chicken stews in light of South Africa's new salt regulations

“…However, legislating salt levels in commercial foods is only one part of a national strategy. It is important for health professionals and educators to also provide appropriate practical nutrition education and promotion that will educate, motivate and enable consumers to change their dietary behaviour in a more healthy direction (Newson et al, 2013;Wentzel-Viljoen, Steyn, Ketterer, & Charlton, 2013). In addition, it is important to consider the impact of salt reduction on taste perception and liking of reduced-salt foods to ensure that consumers will like (or even prefer) these reformulated food products (Herbert, Bertenshaw, Zandstra, & Brunstrom, 2014;Liem, Toraman Aydin, & Zandstra, 2012;Willems, van Hout, Zijlstra, & Zandstra, 2014).…”

Assessment of salt intake behaviour among undergraduate health care students studying in London

“…15 Though available research suggest negative health impact of salt intake, the understanding related to behaviour of salt intake is not clear and profuse. 16 The objective of the present study is to assess the extent of salt intake behaviour among undergraduate health care students studying in a university in London.…”