Salt Reduction Results: Reducing Daily Intake By Four Grams Most Effective In Reducing CVD Risk: A 30-Year Modeling Study
It is known that a high sodium intake increases the risk of blood pressure and hypertension, acting as a precursor of cardiovascular disease (CVD).
Singapore’s daily salt intake is estimated at 9 grams per day, according to the 2018 National Nutrition Survey. The World Health Organization recommends a maximum of 5 g of salt per day.
In Singapore, several campaigns were launched such as the War on Salt campaign in 2011 which saw the development of healthier salt with 25% less sodium than regular salt, among other initiatives.
The Healthier Choice Symbol program has also been launched for packaged foods labeled “ Lower in Sodium ” on foods that are 25% less sodium than similar products.
However, the average daily salt intake has remained roughly the same since 2011.
There are currently no large-scale estimates studying the impact of these interventions on the chronic disease outcome of the Singaporean population.
For example, researchers at the Saw Swee Hock School of Public Health at the National University of Singapore conducted a study to model the impact of different salt reduction interventions over the next 30 years.
The study was published in the journal Nutrients.
For this study, the researchers evaluated the effects of a daily reduction of 0.5, 2, and 4 g of salt.
The study modeled four demographic groups, the general population, the elderly (65 years and older), overweight and obese people (BMI over 23), and people with diabetes.
The last three groups are considered high risk groups for CVD incidence.
Researchers looked at the impact of different salt reduction interventions on the number of avoided incident cases of acute myocardial infarction (AMI) and stroke through 2050.
They used data from existing systematic reviews and meta-analyzes to model the impact for the next 30 years.
Data were obtained from the Singapore Myocardial Infarction Registry and the Singapore Stroke Registry.
The researchers used information from the 2010 National Nutrition Survey to obtain information on salt intake.
The biggest reduction
Based on the results, a 4g / day reduction in salt intake was more effective when applied to the general population, preventing 24,000 out of 30 incident cases of cardiovascular disease. years.
When targeted to specific high-risk demographic groups, the greatest effects were seen in overweight and obese people, with the same intervention (4 g / day) producing 10,500 avoided incident cases of cardiovascular disease (3,000 AMI , 7500 AVC).
The results also showed that a reduction of 0.5 and 2.0 g / day in salt intake in the general population showed a similar trend to the 4 g / day intervention, but at a slower pace.
Based on these results, implementing a population-wide reduction of 4.0 g in daily salt intake prevented the highest incidence of stroke and AMI , with the greatest effect in the overweight population.
“If a population-wide intervention was not possible, however, a 4.0 g reduction in overweight would be very effective.The researchers said.
Interventions involving the elderly group did not bring great benefits in preventing cases of AMI and stroke over the 30-year period.
The researchers think “People in this high-risk stratum may have had long-term high salt intake and subsequent organ damage. Either way, this group should be prioritized as a key target group for salt reduction interventions through careful management of their daily salt intake, which can effectively reduce their risk of mortality and improve their quality. of life.. “
Salt in the diet
In most Western countries, about 75% of dietary salt comes from processed and restaurant-prepared foods, but in Singapore, 75% of the intake comes from table salt, sauces and seasonings added when cooking. food.
Efforts to reduce sodium intake must therefore address these sources.
According to Dr. Salome Rebello, a lecturer at the Saw Swee Hock School of Public Health at the National University of Singapore, people may consider using low sodium salts at home.
“Replacing processed foods like chips, instant noodles or cookies with less processed options like fruits or unsalted nuts, is also a general guideline for consumers to reduce their sodium intake.“, Did she say FoodNavigator-Asia.
The Singapore government has also introduced a Whole Government Healthier Dining Policy (WOG) which will see caterers using low sodium salt, sauces or seasonings starting in May 2021.
Rebello was not involved in the current study.
Limitations and recommendations
The researchers acknowledged that the study had some limitations.
“It was assumed that the relative risk reductions affected all strata of the population equally, when in reality a dose-response relationship would be observed. People with a much higher base salt intake would benefit more from salt reduction interventions than those who only slightly over-consume salt in their diet.. “
Despite these limitations, the results suggest prioritizing overweight and obese populations as key target intervention groups of salt reduction programs in Singapore.
This could be achieved through comprehensive and large-scale public health education, regulation of the salt or sodium content in processed foods, and encouraging the use of healthier ingredients by the food and vegetable industry. drinks, especially in hawking centers (Singapore local food centers), short foods and fast food restaurants.
Rebello added: “Labeling of restaurant foods to indicate salt levels may be a measure considered to help people make wiser decisions and to motivate reformulation among retailers.. “
Initiatives to reduce salt levels in processed and ready-to-eat foods in supermarkets should also be considered.
“Assessing the Impact of Salt Reduction Initiatives on the Burden of Chronic Disease in Singapore”
Authors: Borame L. Dickens, et al.