12 January - 20 June 2016

Effectiveness of salt reduction interventions – review

A review published in PLOS One by researchers from the University of Liverpool and University of Warwick, has analysed the evidence on the effectiveness of salt reduction interventions. Different strategies have been used to try and achieve WHO’s goal of a maximum adult salt intake of 5g/day. This includes individual level intervention, national salt reduction strategies, and notable policy approaches.

A review published in PLOS One by researchers from the University of Liverpool and University of Warwick, has analysed the evidence on the effectiveness of salt reduction interventions.  Different strategies have been used to try and achieve WHO’s goal of a maximum adult salt intake of 5g/day.  This includes individual level intervention, national salt reduction strategies, and notable policy approaches.

Using six electronic databases, Hyseni et al. searched for papers which focused on the effectiveness of population interventions to reduce salt intake. The papers were split into nine categories: dietary counselling, media campaigns, nutrition labelling, voluntary and mandatory reformulation, regulatory and fiscal interventions, and comprehensive strategies. The researchers included 70 papers in their systematic review.  Two individual assessors assessed the quality of the papers included using a scale of poor, fair or good. 

The results of the review suggest that strategies involving entire populations could generally achieve the largest reduction in salt consumption. Fifteen multi-component intervention studies (reformulation, food labelling and media campaigns) were included with these coming from Japan, Finland and the UK.  In Finland and Japan salt intake was reduced by 4g/day, Turkey 3g/day and recently in the UK 1.3g/day.  Three studies focused on mandatory reformulation alone and salt reduction.  The findings of these studies suggest mandatory reformulation alone could achieve a reduction of approximately 1.45g/day followed by voluntary reformulation (-0.8g/day).  The review also included three school based interventions.  It found that a nutrition programme in schools based on healthy and less healthy choices reported “a non-significant reduction.” However a second randomised control trial showed a significant net reduction of 0.7g/day compared with the control group. The third school study also found that education and training significantly reduced salt intake by -1.9g/day in school children and -2.9g in adults.  Short term dietary advice was found to reduce salt intake by -0.6g/day.  Nutrition labelling papers suggest that labelling might modestly reduce UK salt intake by 0.4g/day. However each of the reductions strategies showed a wide range.

The review continues by reporting that tax and community based counselling could each typically reduce salt intake by 0.3g.day whilst even smaller population benefits were derived from health education media campaigns (-0.1g/day).  Worksite interventions achieved an increase in intake +0.5g/day however with a very wide range.  Long term dietary advice could achieve a -2g/day reduction however smaller reductions might be expected in unselected individuals. 

In conclusion the authors reiterate their findings noting that multiple component and upstream population wide policies such as mandatory reformulations generally appear to achieve larger reduction in population-wide salt consumption than downstream individually focussed interventions.  This effectiveness hierarchy might deserve a greater emphasis in future NCD prevention strategies.

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