Salt Reduction Initiatives in the Eastern Mediterranean Region and Evaluation of Progress towards the 2025 Global Target: A Systematic Review

Abstract

This study aims at identifying national salt reduction initiatives in countries of the Eastern Mediterranean Region and describing their progress towards the global salt reduction target. A systematic review of published and grey literature was conducted. Key characteristics of strategies were extracted and classified according to a pre-defined framework: salt intake assessments; leadership and strategic approach; implementation strategies; monitoring and evaluation of program impact. Salt intake levels were estimated in 15 out of the 22 countries (68%), while national salt reduction initiatives were identified in 13 (59%). The majority of countries were found to implement multifaceted reduction interventions, characterized by a combination of two or more implementation strategies. The least common implementation strategy was taxation, while the most common was reformulation (100%), followed by consumer education (77%), initiatives in specific settings (54%), and front of pack labelling (46%). Monitoring activities were conducted by few countries (27%), while impact evaluations were lacking. Despite the ongoing salt reduction efforts in several countries of the region, more action is needed to initiate reduction programs in countries that are lagging behind, and to ensure rigorous implementation and evaluations of ongoing programs. Such efforts are vital for the achievement of the targeted 30% reduction in salt intake.

The Sweet and Salty Dietary Face of Hypertension and Cardiovascular Disease in Lebanon

“…Efforts to reduce and sugar intake rather timid in Lebanon. and action plans salt or intake reduction are lacking (Al-Jawaldeh al., 2021), and there has been no establishment of national targets for the population intake levels (Al-Jawaldeh et al, 2021). This of concern given that governmental commitment has been described an essential prerequisite for nutrition policy development and implementation to facilitate the availability and consumption of safe and nutritious foods that make up a healthy diet, low salt and low sugar diets (Mozaffarian al., 2018).…”

Unhealthy Dietary Habits and Obesity: The Major Risk Factors Beyond Non-Communicable Diseases in the Eastern Mediterranean Region

“…In 2010, within EMR countries the highest mean salt intake has been recorded in Bahrain (14 g/day) followed by Libya, Morocco, Qatar, Syria, and Tunisia (11 g/day) ( 11 ) (see Table 4 ). Conversely, according to more recently collected data based on urinary excretion, the highest level of salt intake was observed in Morocco (10.6 g/day), while the lowest was observed in Lebanon (5.6 g/day) and the UAE (6.8 g/day) ( 19 ). Based on dietary assessment questionnaires, the highest levels of salt intake were observed amongst Iranian children and adolescents (14.3–16.2 g/day) and adults in Bahrain (9.3–13.3 g/day) and Lebanon (10.9 g/day).…”

“…Based on dietary assessment questionnaires, the highest levels of salt intake were observed amongst Iranian children and adolescents (14.3–16.2 g/day) and adults in Bahrain (9.3–13.3 g/day) and Lebanon (10.9 g/day). Per capita estimates were also high in Oman (11.5 g/day) and Tunisia (10.2 g/day) ( 19 ). Sodium is an essential nutrient necessary for the maintenance of plasma volume, acid-base balance, the transmission of nerve impulses, and normal cell function ( 95 ).…”

“…The majority of countries were discovered to be implementing complex reduction measures, which included two or more implementation strategies. Taxation was the least popular implementation option, whereas reformulation was the most popular (100%), followed by consumer education (77%), initiatives in specialized situations (54%), and front-of-pack labeling (46%) ( 19 ).…”

Shifting to a Sustainable Dietary Pattern in Iranian Population: Current Evidence and Future Directions

“…The National Action Plan for Prevention and Control of NCDs in Iran has strongly focused on reducing sodium/salt intake as well as saturated and trans-fatty acids in oils by 2025 (27). In line with these policies, several regulatory policies/programs have been Universal fortification along with small dietary shifts represents an approach to improve the vitamin D status of the general population, at a high acceptability without affecting the carbon footprint (83) implemented to tackle NCDs, e.g., setting a mandatory upper limit of salt in bread (59,60), food reformulation initiatives for reducing the amount of sugar, salt, and fat, specifically the industrially-produced trans-fatty acids in industrial food products (61,62), sin tax policy on increasing the price of sugarsweetened beverages (SSB) (63), traffic light nutrition labeling for more than 80% of the manufactured food products (64), and educational interventions/campaigns to improve awareness and food choices of consumers (65). In addition, the national FBDG, as one of the main tools to raise awareness with respect to appropriate and healthy diet, has been in place since 2005 (24).…”