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Reducing salt intake in Asia-Pacific essential for blood pressure control

Audrey Abella
11 Oct 2017
Prof Graham MacGregor

Reducing salt intake, particularly among individuals in the Asia-Pacific (APAC) region, is of paramount importance as it is essential for alleviating hypertension, according to a presentation at APCH 2017.

“There is an urgent programme to reduce salt intake … [in APAC which] has the highest salt intake in the world, particularly in northern China, northern Japan, and Korea where salt intake is extremely high,” said Prof Graham MacGregor from the Wolfson Institute of Preventive Medicine in the UK. “In the UK, [we believe that] salt added to food is a chronic poison that slowly [increases] our blood pressure (BP) and is a major cause of death and disability particularly through strokes.”

According to the Global Burden of Disease, hypertension is the single biggest cause of death in the world, accounting for about 10 million deaths per year worldwide. [Lancet 2012;380:2224; JAMA 2017;317:165]. There is also evidence showing that the risk of stroke or cardiovascular deaths may start even with a systolic BP of 115 mm Hg. [Lancet 1990;335:765-774]

Salt intake cannot be avoided as we are passive salt consumers, noted MacGregor. Given this, as well as the strong correlation between salt intake and hypertension, government/public health education and media campaigns are strongly advocated to reduce population BP and control high BP through salt intake reduction. “If we did [these] strategies, [even small BP reductions can lead to] a massive reduction in strokes, heart failure, and heart attacks.”

In a school-based randomized study in China, salt intake decreased by an average of 2 g/day (from 7 to 5 g/day) in children who were educated about the dangers of salt, and by 3 g/day (from 12 to 9 g/day) in adult family members whom the children shared their lessons with. [BMJ 2015;350:h770] “If this policy was long-term and spread across the whole of China, it would prevent [approximately] 200,000 cardiovascular deaths per year,” said MacGregor.

Additionally, evidence shows that a 5–6 g reduction in salt intake may prevent approximately 1.5 million stroke and heart deaths per year in the APAC region. [BMJ 2013;346:f1325; Hypertension 2003;42:1093-1099]

In the UK, an ‘incremental reformulation’ programme launched in early 2000 involved a progressive salt reduction target to 6 g across the whole food spectrum, shared MacGregor. This project was a success, effectively managing hypertension and its consequences, and worked counterintuitively as it did not require diet modification, he added.

The study results and the UK programme demonstrate how interventional and educational measures may impact the public and guide them towards a healthier lifestyle, noted MacGregor.

Furthermore, the food industry is encouraged to participate in public health policies that require them to gradually remove or decrease the excessive amount of salt incorporated in their products, noted MacGregor.

Salt intake regulation in APAC is essential, said MacGregor, as ‘very little is going on’ as opposed to regions such as the US, Canada, Australia, and Europe, which have followed the UK model, with South America not far behind. He expressed interest in collaborating with health organizations in APAC to share public health programmes being implemented in the UK.

“We would [like to] give them advice and work with them … to try and encourage more active salt reduction in this area … Every country in the world must set up a salt reduction programme [and] implementing that plan is the important thing. It’s the single most cost-effective public health measure,” concluded MacGregor.

 

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