Salt Reduction Initiatives around the World – A Systematic Review of Progress towards the Global Target

Abstract

ObjectiveTo quantify progress with the initiation of salt reduction strategies around the world in the context of the global target to reduce population salt intake by 30% by 2025.MethodsA systematic review of the published and grey literature was supplemented by questionnaires sent to country program leaders. Core characteristics of strategies were extracted and categorised according to a pre-defined framework.ResultsA total of 75 countries now have a national salt reduction strategy, more than double the number reported in a similar review done in 2010. The majority of programs are multifaceted and include industry engagement to reformulate products (n = 61), establishment of sodium content targets for foods (39), consumer education (71), front-of-pack labelling schemes (31), taxation on high-salt foods (3) and interventions in public institutions (54). Legislative action related to salt reduction such as mandatory targets, front of pack labelling, food procurement policies and taxation have been implemented in 33 countries. 12 countries have reported reductions in population salt intake, 19 reduced salt content in foods and 6 improvements in consumer knowledge, attitudes or behaviours relating to salt.ConclusionThe large and increasing number of countries with salt reduction strategies in place is encouraging although activity remains limited in low- and middle-income regions. The absence of a consistent approach to implementation highlights uncertainty about the elements most important to success. Rigorous evaluation of ongoing programs and initiation of salt reduction programs, particularly in low- and middle- income countries, will be vital to achieving the targeted 30% reduction in salt intake.

Asian American Dietary Sources of Sodium and Salt Behaviors Compared with Other Racial/Ethnic Groups, NHANES, 2011-2012

“…23 Local sodium reduction strategies include introduction of nutrition standards at city agencies, 24 educational media campaigns, and multiple efforts by community-based and other national organizations including the American Heart Association. 23,[25][26][27] While increasing prioritization has been placed on reducing average population sodium intake, [5][6][7]28 limited evidence to monitor intake suggests no change or increases, which may in part be due to policies that, by design, may not reach all subpopulations. In the United States, Changes in sodium intake over time have also been reported using repository-based analyses of spot urine samples and application of recalibration equations to estimate 24-hour excretion in NHANES.…”

Right Here, Right Now: Situated Interventions to Change Consumer Habits

“…Outside of the laboratory, existing interventions that add health-related warning labels directly to food packaging also seem effective in changing behavior. The mandatory inclusion of a salt warning ('high salt content') on food products in Finland, for example was linked with population-level reductions in salt intake (He and MacGregor 2009;Trieu et al 2015; see Figure 3). Similarly, the addition of artificial sweetener warning labels on sugary drinks in the US was also associated with decreased sales of these products (Schucker et al 1983; note that these labels were removed in 2000).…”

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

“…71 Many countries (eg, the UK, Finland, Japan, and Brazil) have already implemented or are considering implementing (eg, the USA) policies to reduce sodium intake. [71][72][73][74][75] Reports from countries with high levels of sodium intake (eg, Japan) that have successfully implemented sodium reduction policies have argued for the benefi cial eff ects of a lowering of sodium intake in these populations. 76 Although multiple lines of epidemiological evidence support the harmful eff ects of very high levels of sodium intake, no scientifi c consensus has been reached on the optimal level of sodium intake.…”