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Salt Worldwide Action: Graham A Macgregor

1) Salt intake is a major cause of raised blood pressure, which is the leading cause of death worldwide. Reducing salt intake is a very cost-effective way to reduce blood pressure. 2) The UK has successfully reduced population salt intake through a strategy targeting reductions in processed foods by the food industry and reductions in table and cooking salt. This is projected to prevent thousands of deaths annually. 3) Reducing salt intake globally could prevent millions of cardiovascular deaths each year at very low annual costs per person compared to tobacco control strategies. International action on salt intake through food industry cooperation and public health campaigns is urgently needed.

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78 views21 pages

Salt Worldwide Action: Graham A Macgregor

1) Salt intake is a major cause of raised blood pressure, which is the leading cause of death worldwide. Reducing salt intake is a very cost-effective way to reduce blood pressure. 2) The UK has successfully reduced population salt intake through a strategy targeting reductions in processed foods by the food industry and reductions in table and cooking salt. This is projected to prevent thousands of deaths annually. 3) Reducing salt intake globally could prevent millions of cardiovascular deaths each year at very low annual costs per person compared to tobacco control strategies. International action on salt intake through food industry cooperation and public health campaigns is urgently needed.

Uploaded by

Smarc
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Salt

Worldwide Action
Graham A MacGregor
Professor of Cardiovascular Medicine
Chairman of WASH
Wolfson Institute of Preventive Medicine,
Barts and The London School of Medicine & Dentistry, UK

Salt Reduction
WHY?
Salt is the major cause of raised BP
(Biggest cause of death)
Very cost-effective to implement

BP - Major Cause of Death Worldwide


Raised Blood Pressure

7 million

Tobacco

Developed region

High cholesterol

Developing region

Underweight
Unsafe sex

Millions of Deaths

62% of all strokes


Raised BP

49% of all heart disease


Ezzati et al. Lancet 2002:360:1347-60.

Systolic BP and Risk of Death


Stroke Deaths

Risk

Heart Deaths

32

16

16

Risk

1
120 125 135 148

168

120 125 135 148

168

Systolic Blood Pressure (mmHg)

The risk starts in the normal range;


at systolic 115 mmHg (83% adults)
MacMahon et al. Lancet 1990;335:765-74

Brain (cross section)

Mid line shift due to


raised pressure

Cerebral
haemorrhage

Atheroma in Carotid Artery


Plaque
Ulcerated
Plaque

Fissured Plaque
with Thrombosis

Evidence for Salt BP


Epidemiology

Over 50 population studies and Intersalt

Migration

e.g. Kenya

Intervention

Portuguese villages. New born babies

Genetic

All defects impair ability of the kidney to excrete Na

Mechanisms

Plasma Na, corrected volume expansion

Animal

BP caused or aggravated by salt (e.g. chimpanzees)

Treatment

Trials, Meta-analysis. Dose response

Mortality studies

Finland (24h UNa)

Outcome trials

TOHP, Taiwan (mineral salt: high K, low Na)


He & MacGregor. Prog Cardiovasc Dis. 2010;52:363-382

Salt Intake 5-6 g/day


Stroke 24%

UK

CHD 18%
35,000 deaths prevented
per year

Worldwide 2.5 million deaths


prevented per year
He & MacGregor. Hypertension 2003;42:1093-99

How to Salt Intake


Measure amount and sources of salt

Plan
Added
Cooking/Table
Sauces

Public health
campaign

Food industry
Processed food
Eating out

Set targets for each


food group
Campbell, et al. JHH. 2011

CASH Strategy for Reducing Salt in UK

Salt intake
Source

g/day

Reduction
needed

Target intake
g/day

Table/Cooking (15%)

1.4 g

40% reduction

0.9 g

Natural (5%)

0.5 g

No reduction

0.5 g

Food industry (80%)

7.6 g

40% reduction

4.6 g

Total 9.5 g

Target 6.0 g

The food industry needs to slowly reduce salt


content of all foods by 40% over the next 5 years
www.actiononsalt.org.uk

The voluntary carrot and stick


approach
food
industry

www.actiononsalt.org.uk

UK Success by 2008
Salt intake has fallen within 3 yrs

from 9.5 to 8.6 g/d salt (10% )


i.e. 26,000 tons/yr salt removed
6000 deaths/yr strokes, heart attacks prevented
www.actiononsalt.org.uk

UK Success 2011
Processed food products 20-50%
1. No taste problems
2. No technical problems
Food outside home now being tackled
Table and cooking salt sales 40-50%
Salt intake should reach less than 6 g/d target
around 2014 (i.e. within 7 yrs)
www.actiononsalt.org.uk

Cost-effective Analysis
UK (NICE)
Cost of salt campaign 5 million per year
Healthcare savings 1.5 billion per year

http://guidance.nice.org.uk/PH25

Salt Reduction vs. Tobacco Control


(low & middle income countries)

15% salt
Number of
CVD deaths
averted in
10 yrs
(millions)

20% smoking

10
9
8
7
6
5
4
3
2
1
0.40
0

0.30

Annual
cost per
person
(US$)

0.20

0.10

0.00

Asaria et al.
Lancet.
2007;370:2044.

Worldwide Action
1.

USA, Canada, Australia following UK model

2.

Europe (ESAN) 16% reduction over 4 yrs

3.

PAHO: Brazil sets targets, Chile, Argentina, Mexico following

4.

Asian-Pacific: Salt intake is very high, e.g. China, Japan, Korea.


Urgent need to reduce salt

Global Food Industry could play a much more prominent role

Unilever & Pepsico worldwide salt reduction across their products

Kelloggs, Nestle about to reduce salt globally to UK levels

www.worldactiononsalt.com

WASH Action Groups

www.worldactiononsalt.com

Hidden Salt in Food

e.g. processed, fast, takeaway, restaurant food

Food industry slowly reduce


- No rejection by public

Fantastic for Public Health

Very little
cost

BP

No need to
change diet

www.worldactiononsalt.com

Salt - Summary
Every country in the world must now
1. Set up salt reduction plan
2. Implement the plan

This is the single most


cost-effective public health measure
It would be negligent for any
government not to take action now
www.worldactiononsalt.com

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