Salt reduction strategies are failing to reduce UK health inequalities: BMJ study

By Will Chu

- Last updated on GMT

The World Health Organisation (WHO) recommends that adults consume less than 5 g (just under a teaspoon) of salt per day. ©iStock
The World Health Organisation (WHO) recommends that adults consume less than 5 g (just under a teaspoon) of salt per day. ©iStock
Salt reduction strategies in the United Kingdom (UK) are more effective amongst the wealthier, health-conscious members of the country’s population, according to a study published in the British Medical Journal (BMJ).

According to the researchers, current strategies such as awareness campaigns, food labelling and voluntary reformulation are more geared towards this demographic.

The study said that current policies had not reduced socioeconomic inequalities in cardiovascular disease (CVD) and likely increased inequalities in gastric cancer cases.

However, additional legislative policies from 2016 may reduce inequalities, the study said. Similarly for gastric cancer, the cases that could be prevented or postponed may have a neutral impact on inequalities.

Previous research​ has pointed towards the worsening of the socioeconomic gradient in salt consumption. In the UK, salt consumption has been found to be higher​ in poorer populations.

"In the UK, salt consumption is excessive overall and even higher in more deprived groups,“​ said Dr Chris Kypridemos from the Department of Public Health & Policy, University of Liverpool.

"Interventions aiming to reduce salt consumption should ideally aim to also reduce socioeconomic inequalities in health through structural policies, such as mandatory reformulation of processed foods."

Salt policies worldwide

bread uk britain folate folic acid flour iStock.com eyegelb
Salt is often found in high amounts in processed foods such as breads, processed meat and snack foods, as well as in condiments (e.g. soy source, fish source).©iStock/eyegelb

Structural salt reduction policies are usually based on legislative initiatives like a mandatory reformulation of processed foods or taxation of high-salt foods.

Such policies have already been adopted successfully in Portugal and Hungary. Further afield Argentina and South Africa have adopted salt restrictions, highlighting their viability.

“The actual number of countries currently implementing legislative measures has substantially increased since 2010, indicating a global move towards stricter salt reduction policies,”​ the study stated.

Researchers from the University of Liverpool looked at the effect current UK salt policies had on the population between 2003 and 2015.

This was then compared to a scenario that assumed salt intake followed pre-salt reduction strategy levels before 2003.

Back then the UK government recommended an average salt intake for the population at 9  grams per day (g/day).

Previous evidence has found mean salt consumption decreased from 9.5 to 8.1 g/day between 2001 and 2011 – some way short of the national target of 6 g/day.

Scenario to 2030

Next, the study team tested additional legislative policies (e.g. mandatory reformulation of processed foods) that they believed would achieve a further decline in salt consumption.

The effectiveness of this policy was compared to the scenario that the decrease in salt consumption seen between 2001 and 2011 would continue up to 2030.

The team declared that since 2003, current salt policies have prevented or postponed approximately 52 000 CVD cases or around 10 000 CVD deaths.

The researchers also thought current policies prevented approximately 5000 new cases of gastric cancer and that around 2000 fewer deaths have been prevented.

In the scenario running to 2030, the study thought that the inclusion of additional policies from 2016 could prevent or postpone around 19 000 cardiovascular disease cases and 3600 cardiovascular disease deaths by 2030.

This reduction in cases was also seen in gastric cancer, where 1200 cases and 700 deaths could be prevented or postponed.

The UK has some of the most comprehensive salt reduction initiatives that include public awareness campaigns, food labelling and 'voluntary' reformulation of processed foods,

Excess salt consumption has been strongly linked with an increased chance of cardiovascular complications and gastric cancer.

On a worldwide scale, over 1.5 million cardiovascular condition-related deaths annually are attributed to individuals exceeding recommended salt levels.

Source: BMJ Open

Published online ahead of print:  doi.org/10.1136/bmjopen-2016-013791

“Estimated reductions in cardiovascular and gastric cancer disease burden through salt policies in England: an IMPACTNCD microsimulation study.”

Authors: Chris Kypridemos, Maria Guzman-Castillo, Lirije Hyseni, Graeme Hickey, Piotr Bandosz, Iain Buchan, Simon Capewell, Martin O'Flaherty.

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