Sodium reduction
High-sodium diets drive nearly two million deaths annually – while switching to potassium- enriched salt could cut that by up to 12%.
The numbers speak for themselves – the WHO’s Noncommunicable Diseases Data Portal (2022) estimates the global mean intake of adults is 4310 mg/ day sodium (equivalent to 10.78 g/day salt), or more than double its recommendation for adults of less than 2,000 mg/day sodium (equivalent to < 5 g/day salt). And according to the Institute for Health Metrics and Evaluation (IHME), an estimated 1.9 million deaths were attributable to high-sodium diets in 2021 alone. Yet as Alyssa Palmquist, Communications Officer, WHO is quick to point out, “There is currently no global guidance on the use of low-sodium salt substitutes, adding, “it was considered important to review existing evidence on the health effects of the intake of low-sodium salt substitutes in a systematic manner and issue a WHO guideline through the current WHO guideline development process.” This guideline is scheduled for release at the end of 2024 and while potassium is currently used in food reformulation in some countries, there are data gaps that need to be addressed in order to evaluate its impact on public health.
Reducing intake is one thing, changing the cultural habits of a lifetime is entirely another, especially where such habits vary at the local level. In many high-income countries, for example, approximately 75% of salt in the diet comes from processed foods and meals prepared outside the home. In many low and middle- income countries, most sodium consumption comes from salt added at home in the cooking process.
Reformulate, change the labelling While food manufacturers have demonstrated that they’re able to lower the sodium content in their products they’re still not doing enough, says Dr Kathy Trieu, senior research fellow in Food Policy at the Australia-headquartered George Institute for Global Health, an institute with two decades of interest in potassium-enriched salt and a world leader in the field.
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In 65 countries, each government has established initiatives to encourage the food industry to reformulate their products where initiatives are voluntary, for example, manufacturers can choose to reformulate or not, there has been limited progress in reducing sodium in products. “Unfortunately, most countries are not on track to achieve the WHO’s goal of a 30% reduction in salt intake by 2025 and only 5% of countries have comprehensive sodium reduction policies in place,” explains Trieu. “Switching the type of salt we use is a proven and effective way to cut costs and live longer, healthier lives,” says Trieu. Earlier this year, The George Institute convened an online policy roundtable with Resolve to Save Lives (RTSL), bringing together industry stakeholders to better understand priorities for scaling up potassium- enriched salt. This included increasing demand while simultaneously reducing costs and raising awareness about the existence and benefits of consuming these products. “Many people don’t know that potassium- enriched salts are an option and haven’t learned about their health benefits. This is true for both consumers and healthcare providers – who otherwise might suggest potassium-enriched salt to their patients. Lack of awareness also means low demand – and with low demand it is not surprising that availability is an issue,” Trieu adds. At present potassium-enriched salt is available in 24% of countries worldwide – 60% of which are high-income countries. Yet even when available, potassium-enriched salt is typically limited to a single brand, necessitating increased visibility and access in supermarkets. According to Trieu, industry-related research to increase the scale-up of potassium-enriched salt is being undertaken in a number of areas, including understanding government policies across the globe, as well as reviewing labels and claims on potassium-enriched salt globally and whether it’s evidence-based. This work provides example text for a standardised label.
Everyone has a part to play China and India are coming under particular scrutiny after extensive research was carried out in those markets. For example, unpacking the rural China study – which comprised 600 villages and 20,000 inhabitants testing the impact of potassium- rich salt over a five-year period versus a regular salt diet – the results found that the low-sodium group had blood pressure 14% lower on average than the control group and had a corresponding 14% lower average risk of stroke. Cardiovascular problems were also 13% less common, which contributed to an overall 12% lower risk of premature death,
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