Sodium reduction
and a population study, and that of SBP on CVD risk from pooled cohort studies. Those findings can now be a platform for pushing forward change on a global scale.
In China, most people consume salt by adding it to their food when they cook.
In the study, one group continued to consume normal salt (sodium chloride), while the second group was provided enough salt substitute (25% potassium chloride) to cover all household cooking and food preservation requirements – about 20g per person per day – free-of-charge. After five years, the results were striking. In the second group, the risk of stroke fell 14%, the risk of major cardiovascular events by 13% and the risk of death by 12%.
“To ensure a level playing field, clear timeframes were given for the salt targets to be met, and industry compliance was closely and independently monitored.”
Dr Monique Tan
“We’ve been trying to change the amount of salt people eat for 20 years in Australia and elsewhere, but it’s been very hard to get people to change their behaviour and we have almost universally failed,” Neal remarks.
“Potassium-enriched salt looks the same, tastes the same and can be used just like regular salt, so it’s really easy for people to make the switch and stick with it. At the end of the study, 93% of people were still using the salt substitute.”
From China to the world 20,000
China’s recent Salt Substitute and Stroke Study, spans five years and involves this many participants from 600 rural villages in China.
Salt Substitute and Stroke Study (SSaSS)
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As part of a larger programme – ‘Action on Salt China’ – a global health research unit funded by the UK National Institute for Health and Care Research and a partnership between Queen Mary University of London, The George Institute China, and several Chinese health authorities has set out to develop salt reduction strategies. Tan plays a key role in that research and, in a study published in BMJ Nutrition, Prevention & Health, found that reducing daily salt intake in China by even 1g could prevent almost 9m cardiovascular events by 2030. To derive their results, the team extracted the effect of salt reduction on systolic blood pressure (SBP) from a meta-regression of randomised trials
“In China, most of the salt that people consume is the salt they add themselves when they cook or prepare food, either in the form of regular table salt or of high-salt condiments such as soy sauce,” says Tan. “In terms of lowering salt in manufactured foods, what would be needed is for the government to set salt targets for the industry to comply with,” she continues. “This has been done with great success in the UK, for example, which has pioneered this approach by setting progressively lower salt targets for over 85 food categories. To ensure a level playing field, clear timeframes were given for the salt targets to be met, and industry compliance was closely and independently monitored.”
Reinventing the supply chain Tan believes that a gradual reduction in salt intake across the whole population, as recommended by the WHO, is achievable, affordable, and cost- effective. In part, this is because low-sodium, high- potassium salt substitutes are cost-effective. They cost approximately $1.62 per kilo versus $1.08 per kilo for regular salt.
Furthermore, while sodium raises blood pressure, potassium lowers it. Neal believes that the data from SSaSS could lead to a complete reworking of the global salt supply chain. That sounds like a huge challenge, but it has been done before. “Firstly, ingredient suppliers need to have potassium-enriched salt on shelf at minimal cost as a wholesale product,” he says. “From the food manufacturer’s perspective, salt is typically just 1% or 2% of the final product and a very low-cost ingredient. So even if the salt substitute is a bit more expensive it should have almost no impact on food production costs.”
“The global supply chain was already switched once in the past 50 years from regular salt to iodised salt – before this switch people in many areas were not getting enough iodine, which leads to enlargement of the thyroid and neurological impairment in children,” he adds. “Salt is a great vehicle for getting iodine to people but it’s also problematic. You are putting a good thing into a bad thing, which gives salt a veneer of respectability it doesn’t warrant. If we now make another switch from iodised salt to iodised and potassium-enriched salt, we can resolve that anomaly.” From rural China to low-income and mature economies across the world, a huge change could be coming, and food manufacturers must play a pivotal role in making that change happen. ●
Ingredients Insight /
www.ingredients-insight.com
Leszek Kobusinski/
Shutterstock.com
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