Background
Salt reduction strategies should be developed based on the dietary sources of sodium in the local diet.
Using data on the sources of sodium and theoretical dietary modelling, salt reduction program leaders can determine what interventions to prioritise, what food categories to target for reformulation, and what are feasible yet effective sodium content targets to set to achieve a 30% reduction in salt intake.
In Europe, the amount of sodium (in the form of salt) consumed exceeds levels recommended by the World Health Organization, thereby causing elevated blood pressure and increased risk of stroke and coronary heart disease.
A significant proportion of sodium in the diet comes from processed and packaged foods such as bread, processed meats and savoury snacks. The sodium content levels in packaged foods can vary considerably within food categories and between countries, highlighting the scope for sodium reformulation.
Many countries in the WHO European Region advancing their salt reduction strategy requested for more specific guidance on policies to reduce sodium in the food supply.
In 2017, the World Health Organization Regional Office for Europe engaged the George Institute to produce a step-by-step guidance on developing country-specific salt reduction models to determine how to effectively achieve a 30% reduction in population salt intake.
Aim
To outline the steps for developing a country-specific salt reduction model, and determining the level of reduction needed in a) the sodium content of key food contributors, and b) discretionary salt consumption, in order to achieve a 30% reduction in population salt intake
Provide case studies illustrating the process and the output.
To describe how the salt reduction model can be used to guide the design of salt reduction strategies
Share examples of existing sodium targets for manufactured foods to assist with identifying feasible sodium targets for foods.
Research Methodology
The methods for developing a salt reduction model and using it to inform the implementation of the salt reduction initiatives were based broadly on the UK Food Standards Agency salt reduction model.
The UK salt reduction model was integral in the design of an effective voluntary salt reformulation program that resulted in substantial reductions in the sodium content of a range of packaged foods. It also contributed to a 15% reduction in population salt intake, and parallel reduction in blood pressure across the population.
Impact
The guide on developing a country-specific salt reduction model was published (found here) and shared by WHO Regional Office for Europe with country salt reduction program leaders to follow.
Five key steps were identified for developing a country-specific salt model.
Salt reduction models were developed for Kazakhstan and Turkey with input from local researchers, and the process and output were included as case studies.
Subsequently, the George Institute collaborated with WHO Regional Office for Europe and Kazakh Academy of Nutrition to publish the findings of the population survey measuring sodium and potassium intake among adults in Kazakhstan.
Outputs
Using dietary intake modelling to achieve population salt reduction – a guide to developing a country-specific salt reduction model (Found here)
Trieu, K., Ospanova, F., Tazhibayev, S. et al. Sodium and potassium intakes in the Kazakhstan population estimated using 24-h urinary excretion: evidence for national action. Eur J Nutr (2020). (Found here)
Conference presentation at the International Society of Hypertension Scientific Meeting, China: Mean urinary salt excretion in two Kazakhstan regions – one of the highest in the world (Found here)