This GACD 3-year project was undertaken to develop the evidence base required to formulate a national salt reduction program for India. This was done by conducting an integrated, multifaceted research program comprised of stakeholder assessments, population surveys and food supply evaluations. This research will provide the data required to formulate and implement a national salt reduction program for India.

To gather the evidence base for a salt reduction programme in India

The specific objectives for each research component were:

• Stakeholder survey – to obtain a comprehensive understanding of consumer and other stakeholder opinions in relation to the most effective mechanisms for reducing salt intake: Face-to-face in-depth interviews with stakeholders from academia, industry, government, non-government and focus group discussions with consumers.
• Population survey – to estimate the mean daily salt consumption of the Indian population, the main sources of salt in the diet, and population knowledge about the adverse effects of salt on health: 24hr urinary sodium excretion/spot urine samples; 24hr dietary recall survey; demography and anthropometry; knowledge, attitudes and behaviors on salt intake using a questionnaire.
• Food survey – to estimate the mean and variation in the nutritional quality of common processed and restaurant foods: shop survey to capture nutrition information on packaged food available in Hyderabad and Delhi supermarkets.

• By showing what can be achieved at a state level in India, The George Institute will be well-placed to support other countries around the world in achieving a reduction in salt intake

• Johnson, C. Mohan, S, Rogers, K., Shivashankar, R., Raj, TS., Gupta, P…. Neal, B. “The Association of Knowledge and Behaviours Related to Salt with 24-h Urinary Salt Excretion in a Population from North and South India” Nutrients.(2017), 9(2), 144; doi:10.3390/nu9020144
• Johnson, C. Mohan, S, Rogers, K., Shivashankar, R., Raj, TS., Gupta, P…. Neal, B. “Mean dietary salt intake in urban and rural areas in India – a population survey of 1395 individuals”. Journal of the American Heart Association. (2017). 6(1), e004547.
• Johnson C, Mohan S, Praveen D, Woodward M, Maulik PK, Shivashankar R, et al. Protocol for developing the evidence base for a national salt reduction programme for India. BMJ open. 2014; 4(10): e006629
• Johnson,C., Thout, S. R., Mohan, S., Dunford, E., Ferrand, C., Wu, J. H., … & Garg, V. (2017). Labelling completeness and sodium content of packaged foods in India. Public health nutrition, 20(16), 2839-2836.
• Johnson, C., Praveen, D., Pope, A., Raj, T. S., Pillai, R. N., Land, M. A., & Neal, B. (2017). Mean population salt consumption in India: a systematic review. Journal of hypertension, 35(1), 3-9.
• Johnson, C., Santos, J. A., Sparks, E., Raj, T. S., Mohan, S., Garg, V., … & Webster, J. (2019). Sources of dietary salt in north and south India estimated from 24 hour dietary recall. Nutrients, 11(2), 318.
• Petersen, K. S., Johnson, C., Mohan, S., Rogers, K., Shivashankar, R., Thout, S. R., … & Santos, J. A. (2017). Estimating population salt intake in India using spot urine samples. Journal of hypertension, 35(11), 2207-2213.
• Gupta, P., Mohan, S., Johnson, C., Garg, V., Thout, S. R., Shivashankar, R., … & Prabhakaran, D. (2018). Stakeholders’ perceptions regarding a salt reduction strategy for India: Findings from qualitative research. PloS one, 13(8).