New Evidence for Salt Reduction - Government must now force the food industry to take out the huge and unnecessary amount of salt they add to our food
A new meta-analysis by international researchers including authors from the Wolfson Institute, Queen Mary University of London and Action on Salt published in the BMJ (25 February 2020); ‘Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials’ provides new and strong evidence to support salt reduction as a key public health strategy to lower blood pressure and reduce the risk of strokes and heart disease in the UK and worldwide.
The meta-analysis included 133 randomised trials with 12,197 individuals looking at the effect of salt reduction on blood pressure, and showed that salt reduction lowered blood pressure across the whole population, including those with blood pressure within normal ranges. Furthermore, the greater the reduction in salt intake, the greater the fall in blood pressure.
The study also showed that people who are older, have higher blood pressure, or of black ethnicity, had an even bigger fall in blood pressure for a given reduction in salt intake, with longer term reductions likely to have a greater effect.
These findings are important as they indicate that population-wide reduction in salt intake should lower population blood pressure which in itself will cause a large reduction in strokes and heart disease and, at the same time, it is likely to prevent people from developing high blood pressure as they get older.
A second review by researchers at the Wolfson Institute, Queen Mary University of London and Action on Salt and recently published in the JACC (Journal of the American College of Cardiology) (18 Feb 2020) entitled ‘Salt Reduction to Prevent Hypertension and Cardiovascular Disease: JACC State-of-the-Art Review’ is the most comprehensive review to date of all types of research conducted on salt and health.
This review looked at almost 200 published studies and covers not only the mechanisms whereby salt puts up blood pressure, but also other potential mechanisms by which salt can damage our health, including the immune response, gut microbiome, damage to small vessels and brain leading to dementia.
A high salt intake is the major cause of raised blood pressure, which in itself is the leading cause of strokes and heart disease, the biggest causes of death and disability in the UK. Too much salt is also closely linked to osteoporosis, stomach cancer, and kidney disease.
The review also highlights the cost-effectiveness of salt reduction and the benefits to health, which are similar to tobacco reduction or prevention of obesity.
Professor Feng He, lead author of the Review, researcher at Queen Mary University of London and WASH member says:
“The totality of evidence in the JACC review and this latest BMJ research shows that reducing our salt intake will be immensely beneficial. Salt-reduction efforts should be reinforced in the UK and worldwide to save millions of people suffering and dying unnecessarily from strokes and heart disease each year.”
Professor Graham MacGregor, Professor of Cardiovascular Medicine at Barts and The London Hospital and Queen Mary University of London, Chair of WASH and co-author of the Review, says:
“Salt reduction has been identified as one of the most cost-effective strategies to reduce strokes and heart disease. From 2005 to 2011, the UK led the world with an effective, coherent salt reduction policy, by getting the food industry to slowly reduce the huge and unnecessary amount of salt they add to our food. This led to a reduction in population salt intake and fall in population blood pressure, with major reductions in stroke and heart disease deaths. Since 2011, the government has failed to continue this policy and the new government must now force the food industry to start making further reductions in the amount of salt they add to our food, either with legislation or financial penalties for those who fail to comply.”
Up to 2011, the UK salt reduction programme, under the Food Standards Agency (FSA), led the world and had already saved 18,000 strokes and heart attacks per year – with £1.5 billion a year in NHS healthcare saving costs, according to NICE.1 In 2016, Public Health England assumed responsibility for UK salt reduction, and on 6th February 2020 announced a new set of draft voluntary salt targets. However, setting targets without enforcement is unlikely to work – as demonstrated by the failed Responsibility Deal and the lack of progress made by the food industry on the previous set of targets. Instead, what is required is a clear and transparent monitoring programme, to include annual progress reports and strong engagement with the whole sector, along with case studies of successful reformulation to aid industry-wide reformulation. Stronger engagement with the Out of Home sector is also a must in order to create a level playing field. The new progressive government must now learn from the failings of previous governments and either empower PHE to act or better still, set up an independent nutrition agency modelled on the previous FSA. Every 1g reduction in salt intake prevents 7,000 deaths per year, 4,000 of which are premature, from strokes and heart disease – a fact that the Secretary State for Health ignores at his peril.2
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Notes to editors:
About Action on Salt
Action on Salt is a group concerned with salt and its effects on health, supported by 22 expert scientific members. Action on Salt is successfully working to reach a consensus with the food industry and Government over the harmful effects of a high salt diet, and bring about a reduction in the amount of salt in processed foods as well as salt added to cooking, and at the table.
In the early 2000’s the UK pioneered a salt reduction strategy with the Food Standards Agency and Action on Salt with the setting of incremental salt targets, so that the food industry was slowly reducing the huge and unnecessary amounts of salt they add to food. This resulted in a fall in UK population salt intake, a fall in average blood pressure and more than 12,000 lives have been saved from preventing strokes and heart disease. However, in 2010 responsibility for salt reduction was switched to the Department of Health and the food industry was made responsible for policing itself, a policy that unsurprisingly failed. Further salt reduction targets were set to be achieved by the end of 2017 but little action has been taken to ensure the food industry is meeting these targets. PHE are now responsible for the UK salt reduction programme but so far have done little or nothing. All of the above has meant that the salt reduction programme has been slowed down with the result that many thousands of people have died unnecessarily and huge and unnecessary costs have been incurred by the NHS. Salt is the forgotten killer; the time has come for PHE to allocate sufficient resources to immediately resuscitate the UK salt reduction programme.
- NICE (The National Institute for Health and Care Excellence). Guidance on the prevention of cardiovascular disease at the population level. http://guidance.nice.org.uk/PH25 (Accessed 13 February 2020).
- Department of Health. Salt reduction – onwards and downwards! https://webarchive.nationalarchives.gov.uk/20180201175801/https://responsibilitydeal.dh.gov.uk/salt-reduction-onwards-and-downwards/ (Accessed 13 February 2020).