salt reduction

7/24/2019 Salt Reduction

1/21

Salt

Worldwide Action

Graham A MacGregor

Professor of Cardiovascular Medicine

Chairman of WASHWolfson Institute of Preventive Medicine,

Barts and The London School of Medicine & Dentistry, UK


2/21

Salt Reduction

WHY?

Salt is the major cause of raised BP

(Biggest cause of death)

Very cost-effective to implement


3/21

Ezzati et al. Lancet 2002:360:1347-60.

Underweight

Unsafe sex

High cholesterol

Tobacco

Raised Blood Pressure

0 1 2 3 4 5 6 7

Millions of Deaths

7 million

Developing region

Developed region

BP - Major Cause of Death Worldwide

49% of all heart diseaseRaised BP

62% of all strokes


4/21

Systolic BP and Risk of Death

Systolic Blood Pressure (mmHg)

Heart Deaths16

8

4

2

1

120 125 135 148 168

Risk

120 125 135 148 168

2

4

8

16

32

Stroke Deaths

The risk starts in the normal range;at systolic 115 mmHg (83% adults)

Risk

MacMahon et al. Lancet 1990;335:765-74


5/21

Cerebralhaemorrhage

Mid line shift due to

raised pressure

Brain (cross section)


6/21

Atheroma in Carotid Artery

Plaque

Ulcerated

Plaque

Fissured Plaquewith Thrombosis


7/21

Epidemiology Over 50 population studies and Intersalt

Migration e.g. Kenya

Intervention Portuguese villages. New born babies

Genetic All defects impair ability of the kidney to excrete Na

Mechanisms Plasma Na, corrected volume expansion

Animal BP caused or aggravated by salt (e.g. chimpanzees)

Treatment Trials, Meta-analysis. Dose response

Mortality studies Finland (24h UNa)

Outcome trials TOHP, Taiwan (mineral salt: high K, low Na)

Evidence for Salt BP

He & MacGregor. Prog Cardiovasc Dis. 2010;52:363-382


8/21

Salt Intake 5-6 g/day

Stroke 24% CHD 18%

Worldwide 2.5 million deathsprevented per year

He & MacGregor. Hypertension 2003;42:1093-99

35,000 deaths preventedper year

UK


9/21

How to Salt Intake

Measure amount and sources of salt

Plan

AddedCooking/Table

Sauces

Food industryProcessed food

Eating out

Public health

campaign

Set targets for each

food groupCampbell, et al. JHH. 2011


10/21

CASH Strategy for Reducing Salt in UK

Table/Cooking (15%)

Natural (5%)

Food industry (80%)

0.9 g

0.5 g

4.6 g

40% reduction

No reduction

40% reduction

Salt intake Reduction

needed

Total 9.5 g

1.4 g

0.5 g

7.6 g

Target 6.0 g

The food industry needs to slowly reduce saltcontent of all foods by 40% over the next 5 years

Source g/day

Target intake

g/day

www.actiononsalt.org.uk


11/21

The voluntary carrot and stick

approach

foodfoodfoodfoodindustryindustryindustryindustry



12/21


13/21


14/21

UK Success by 2008

Salt intake has fallen within 3 yrs

from 9.5 to 8.6 g/d salt (10%

)

i.e. 26,000 tons/yr salt removed

6000 deaths/yr strokes, heart attacks prevented



15/21

UK Success 2011

Processed food products 20-50%1. No taste problems2. No technical problems

Food outside home now being tackled

Table and cooking salt sales 40-50%

Salt intake should reach less than 6 g/d target

around 2014 (i.e. within 7 yrs)www.actiononsalt.org.uk


16/21

Cost of salt campaign 5 million per year

Healthcare savings 1.5 billion per year

http://guidance.nice.org.uk/PH25

Cost-effective AnalysisUK (NICE)


17/21

0.00

0.10

0.20

0.30

0.400

1

23

4

5

6

7

89

10

Number of

CVD deaths

averted in

10 yrs

(millions)

Salt Reduction vs. Tobacco Control

(low & middle income countries)

15% salt 20% smoking

Annualcost perperson(US$)

Asaria et al.Lancet.2007;370:2044.


18/21

Worldwide Action

Global Food Industry could play a much more prominent role

Unilever & Pepsico worldwide salt reduction across their products

Kelloggs, Nestle about to reduce salt globally to UK levels

1. USA, Canada, Australia following UK model

2. Europe (ESAN) 16% reduction over 4 yrs

3. PAHO: Brazil sets targets, Chile, Argentina, Mexico following

4. Asian-Pacific: Salt intake is very high, e.g. China, Japan, Korea.

Urgent need to reduce salt

www.worldactiononsalt.com


19/21

WASH Action Groups

www.worldactiononsalt.com


20/21

Fantastic for Public Health

Very littlecost

Food industry slowly reduce- No rejection by public

No need tochange diet

Hidden Salt in Foode.g. processed, fast, takeaway, restaurant food

BPwww.worldactiononsalt.com


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Salt - Summary

1. Set up salt reduction plan

2. Implement the plan

This is the single mostcost-effective public health measure

Every country in the world must now

It would be negligent for any

government not to take action nowwww.worldactiononsalt.com

salt reduction

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