Speaking ahead of a United Nations High Level Meeting on non-communicable diseases, Professor Francesco Cappuccio and colleagues argue that lowering dietary salt intake has the potential to substantially reduce levels of stroke and heart disease and save millions of lives globally. Studies also show that reducing salt intake is cost saving.
The question, they say, is not whether to reduce salt intake but how to do so.
The World Health Organisation has set a global goal to reduce dietary salt intake to less than 5 g (about one teaspoon) per person per by 2025, yet salt intake in many countries is currently much higher than this.
The authors say this could be done through mass media campaigns and engagement with the food industry to set limits on the salt content of processed foods.
For example, in the UK a reduction of 3 g salt intake per day would prevent up to 8,000 stroke deaths and up to 12,000 coronary heart disease deaths per year.
A similar reduction in the USA would result in up to 120,000 fewer cases of coronary heart disease, up to 66,000 strokes and up to 99,000 heart attacks annually. It would also save up to $24 billion annually in health care costs.
However, changing personal behaviour and choice alone is not an effective or realistic option when the majority of salt is added to food before it is sold and food marketing relies on taste, write the authors. Furthermore, the commercial addition of salt to food is becoming a global trend as the worldwide food economy changes.
A four-pronged approach is therefore required, they say, and should form the base for a comprehensive policy:
- Communication - establishing and evaluating public awareness campaigns
- Reformulation - setting progressive salt targets for reformulating existing processed food and engaging with the food industry in setting standards for new foods
- Monitoring - surveying population salt intake, progress of reformulation, and effectiveness of communication
- Regulation - engagement with industry, including regulation, to create a level playing field so as not to disadvantage more enlightened and progressive companies
"The huge responsibility of food manufacturers in contributing to the epidemic of cardiovascular disease must be acknowledged, and prevention implemented through food reformulation and effective voluntary, market intervention or mandatory action throughout the industry," say the authors.
"Civil society, governments, academia, and health organisations all have a part to play. Denial and procrastination will be costly in terms of both avoidable illness and expenses," they conclude.