Salt reduction: need action from govt

Cardiovascular diseases are the leading cause of death in India. It is responsible for about 2.3 million deaths each year, which is approximately 23% of all mortality. Of these deaths, 24% are attributed to high blood pressure.

High blood pressure is the leading risk for non-communicable diseases in India where the prevalence rates of hypertension are expected to nearly double from 118 million in 2000 to 213 million by 2025. Salt is a leading cause of high blood pressure and has been associated with the risk of vascular disease as well as other serious health problems.

The 2010 Global Burden of Disease study reported excess salt intake to be the seventh leading cause of global mortality responsible for 1.65 million deaths from cardiovascular disease. All member-states of the World Health Organisation (WHO), including India, have adopted a 30% reduction in mean population salt consumption by 2025 as part of the ‘25 by 25’ initiative for the control of non-communicable diseases.

Several studies carried out in the developing countries, like in India, have been reporting an increase in the prevalence of diet related chronic non-communicable diseases (NCDs) like overweight and obesity, diabetes mellitus, hypertension, other cardiovascular diseases (CVDs), cancers etc, especially among urban population.

In support of the development of a national salt reduction strategy for India, the George Institute for Global Health, India has completed a large population survey of dietary salt intake using the 24-hour urine assessment method in urban and rural areas in Delhi/ Haryana and Andhra Pradesh.

Additionally, assessed participant’s knowledge, attitude and behavioural (KAB) practices towards salt consumption and a stakeholder analysis was undertaken involving the government, industry, consumers and civil society organisations as well as a systematic quantitative evaluation of packaged foods available for purchase in Delhi and Hyderabad supermarkets.

There were 1,041 persons selected for the survey in Delhi/Haryana and 712 (68%) agreed to participate. The corresponding number for Andhra Pradesh were 1,291 and 840 (65%). Overall urinary salt excretion was estimated to be 8.59 g/day in Delhi/Haryana and 9.46 g/day in Andhra Pradesh.

Intake was highest in urban slum sites, next highest in rural sites and lowest in slum sites in Delhi/Haryana and the pattern appeared similar in Andhra Pradesh though was not significantly different across area of residence in that state.

In the KAB survey, the majority of participants reported that the maximum salt consumption recommendation as
Of the 7,428 packaged food product data collected between 2012 and 2014, a total of 5,686 individual products were included in the analysis. Total number of products meeting national Food Safety and Standards Authority of India guidelines for nutrition labelling were 2,425 (43%), total number of products labelled for sodium were 2,027 (34%).

Strong case
These data make a strong case for action on salt consumption. While the formation of a salt reduction strategy that will be best suited to India will require the synthesis of this data with multiple other data sources, it is likely that a combination of actions targeting consumers, industry and government will be required.

The available evidence from other jurisdictions and extensive modelling suggest that a salt reduction programme in India would both prevent large numbers of incident cases of hypertension as well as strokes and heart attacks. Further, it is likely that this would be achieved at low total cost and in a highly cost-effective way.

India is one of the first countries to have developed an action plan for meeting the NCDs 10 targets. One of the targets is 30% relative reduction in mean population intake of salt/sodium.

This will also directly help in achieving the other target which is 25% relative reduction in raised blood pressure or contain the prevalence of raised blood pressure.

We need action from the Government of India, food manufacturers, private sector, restaurants, street vendors, cafeteria managers, housewives, civil society and academic and research community.

(The writer is Research Associate, Food Policy Division, The George Institute for Global Health)