Putting the spotlight on salt

by Eric Schroeder
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The debate in the United States regarding the benefits of consuming less sodium has heated up in recent years, but for all the efforts under way in the U.S., they remain a drop in the bucket compared to more broad-based actions taking place globally to drive down sodium consumption.

The World Health Organization this past week published "Reducing Salt Intake in Populations," a report calling for population-wide strategies to reduce salt consumption as a cost-effective way of lowering blood pressure, preventing heart disease, stroke and other health problems. The report, which arose from a committee convened by the W.H.O. this past October, urges governments around the world to reduce average sodium consumption to 2,000 milligrams per day, about half of what Americans consume now.

In an opening session at the meeting, Dr. Michel Chauliac, coordinator of the French Nutrition and Health Plan at the Ministry of Health, elaborated on efforts under way in France to reduce salt intake. In 2004, the French parliament adopted a Public Health Act that set as one of its goals to reduce salt intake to less than 8 grams per person per day.

Dr. Chauliac noted that in France, only 10% of total dietary salt intake comes from salt added during cooking or at the table. As such, Dr. Chauliac said processed food products need to be labeled accordingly. He said any salt added during industrial food processing should be reduced, taking into account the need to add salt for food safety, preservation, processing requirements and taste purposes.

In 2000, the French Food Safety Agency (A.F.S.S.A.) recommended a reduction in salt consumption by the French population and an evaluation of the achievability of a gradual decrease in the salt content of processed foods. As part of the evaluation, several goals were defined, including reducing salt intake in the population by 20%, reducing salt content in those products found to be the most important vehicles of salt and the launch of a public information campaign on overall nutrition.

In an update on the agency’s efforts, Lionel Lafay of the A.F.S.S.A. said progress has been made. Thirty-three per cent of bakers have reduced salt content in their products since 2002, with 82% stating they have received no complaints concerning taste. An additional 13% said they planned additional salt reduction efforts over the next three years. A 7% reduction in salt content of soups was achieved, and new recipes containing less salt were formulated, Mr. Lafay said. In addition, new meat products with lower salt content were developed and a Code of Good Practice on the use of salt was adopted by the cheese industry.

Even with these efforts, Mr. Lafay said "much more work still needs to be done" to achieve the goal of less than 8 grams of salt per day.

The goal of less than 8 grams of salt per day in France is comparable to goals established in other countries. On the high end of the spectrum, Japan recommends less than 10 grams per day, while the recommendation in The Netherlands is 9 grams. More aggressive goals have been established in the United States and Canada (less than 6 grams per day) and in Portugal, Singapore and Brazil (less than 5 grams).

U.K. takes aggressive approach

Like France, the United Kingdom has been at the forefront of countries undertaking ways to reduce salt intake. The U.K. Food Standards Agency (F.S.A.) Strategic Plan set a specific target for the British population to reduce salt consumption to 6 grams per day by 2010.

In a presentation at the W.H.O. forum, Dr. Rosemary Hignett of the F.S.A. said a number of initiatives have been put in place to achieve salt reduction. After an initial assessment of the foods contributing the most sodium to the population, the F.S.A. partnered with the food industry to encourage best practices for the production of less salty foods.

As a result of the F.S.A.’s actions, Dr. Hignett said approximately 20 million more people said they cut down on salt, half of all consumers said they now check food labels for salt, and a 10-fold increase in awareness of the message "no more than 6 grams per day" has been observed.

In research published in mid-March, the F.S.A. said people in Great Britain are consuming less salt than they were five years ago. According to the F.S.A.’s findings, average daily salt consumption has fallen to 9 grams in 2006 from 9.5 grams in 2001, with men consuming 10.2 grams of salt per day, down from 11 grams, and women consuming 7.6 grams, down from 8.1 grams.

"Although the decrease is small, it indicates that things are moving in the right direction and that good progress is being made by both the food industry and consumers," the F.S.A. said. "It highlights that there is still work to be done to meet the government’s national target of no more than 6 grams a day by 2010."

In a survey conducted in late February, the F.S.A. found 40% of respondents claimed to be making a special effort to cut down on salt in their diet, up from 22% in 2004, when the F.S.A. launched its salt reduction campaign. But the F.S.A. said 90% of the people surveyed said they were cutting down on salt by not adding it to their food, with only 15% saying they check labels and 12% saying they are eating less processed food in order to reduce their intakes.

Canadian sodium consumption high

The United States’ neighbor to the north has been waging its own battle against salt and sodium intake in recent years. A study conducted by Statistics Canada and published in the May 2007 issue of Health Reports found Canadians are currently consuming far beyond the recommended upper limit of sodium. The upper limit is defined by Statistics Canada as the highest continuous daily intake of a nutrient that does not appear to carry risks of adverse health effects.

Among individuals ages 19 to 70, the upper limit was surpassed by more than 85% of men and 60% of women. The study, which examined 35,107 people during an initial 24-hour dietary recall in 2004, found the average daily sodium intake for all Canadians was 3,092 mg, one-third more than the maximum. This total does not include salt added at the table or while cooking.

W.H.O. forum makes recommendations

In summarizing the findings from the forum, the W.H.O. highlighted several recommendations from participants, including:

• Governments should consider statutory regulation to lower salt in food products if alternatives to legislation, such as self-regulation or voluntary guidelines, do not result in adequate change after a specified amount of time.

• Health professionals should be trained to counsel patients about the risks of excessive salt intake, about the major sources of sodium in their diets, and how to reduce sodium intake.

• The progress made in terms of product reformulation in some countries needs to be reflected when the same food products are sold in markets in low- and middle-income countries.

"There was consensus throughout the discussions that the current scientific evidence was conclusive about the adverse effects of excessive salt consumption on health," the W.H.O. stated. "Interventions to reduce population-wide salt consumption are highly cost-effective and should therefore be given priority.

"It was also agreed that population-wide salt reduction can be achieved most effectively through a multisectoral and interdisciplinary approach where all relevant stakeholders are actively engaged. Before the implementation of any salt reduction policy, it is important to take into account ongoing initiatives and programs, existing structures and institutions (including N.G.O.s and private sector), as well as existing barriers, including actual legislation and budgetary priorities. Additionally, it was reinforced that in order to succeed, all strategies and interventions should be tailored to the characteristics of the country and populations within it."

Salt part of a balanced diet

Acknowledging there is "great debate" in scientific circles regarding the impact of salt on the diet, Morton Satin, director of technical and regulatory affairs at the Salt Institute, Alexandria, Va., stressed a balanced diet is "the only universally agreed upon course to achieve significant health benefits."

In an interview with Food Business News, Mr. Satin responded to the World Health Organization’s report "Reducing Salt Intake in Populations," by saying governments would be better served by focusing on dramatically increasing the consumption of fruits and vegetables and less on pushing salt reduction. Mr. Satin said increased consumption of fruits and vegetables reduces the majority of risk factors associated with health irregardless of salt intake, but added groups such as the American Medical Association, the Center for Science in the Public Interest and the W.H.O. choose not to go this route because "promoting the consumption of a balanced diet doesn’t put them in the limelight."

"Instead of following a proper course of promoting the greatly increased consumption of fruits and vegetables, W.H.O., the A.M.A. and the C.S.P.I. have simplistically demonized salt and chosen to follow a magic bullet approach to health," Mr. Satin said. "Like all other magic bullet approaches they pursued, this one will ultimately fail."

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