While many economically developed countries have begun to slash salt consumption, efforts to meet World Health Organisation (WHO) targets of 30% lower salt intakes are a tougher prospect in developing countries, according to the team of scientists behind new work that outlines a five-step approach for setting targets for salt levels in foods in low- and middle-income countries (LMICs).
Writing in Food Policy, the international team of researchers warn that in order to achieve the global recommendation to reduce population salt intakes by the targeted 30%, LMICs will need to take action to reduce salt levels in foods, and state that setting targets for the main contributors to dietary salt intake is an important first step.
“LMICs with limited resources should select maximum targets for the main contributors of salt in the diet and use existing targets as the starting point for country or region-specific target development,” wrote the team – led by Shauna Downs from Columbia University and the University of Sydney.
“In addition to setting targets that can be used for setting voluntary or mandatory levels of salt in processed packaged foods, labelling or taxation, interventions at the consumer level are also required,” wrote the team, who also suggested that governments should consider subsidising low salt alternatives to encourage their uptake by both consumers and manufacturers.
Slashing salt
The team noted that the UK was the first country to establish comprehensive salt targets and between 2003 and 2011. The efforts resulted in significantly lower intakes of salt in the UK population, and have been linked to a 40% decline in stroke and a 42% fall in ischemic heart disease.
“This suggests that salt targets could substantially contribute to the global goal to reduce population salt intakes by 30% and help reduce diet-related NCDs, even when they are voluntary,” said the authors.
However, they noted that LMICs may face additional challenges in setting targets for salt levels in foods – “due to a lack of available data for target development and perhaps, more importantly, a lack of capacity for implementation, enforcement and monitoring.”
“For this reason, they will need to adopt a more practical approach to setting country or region-specific salt targets,” said the team.
Five-step approach
In their paper Downs and her colleagues propose LMICs follow a five-step approach to setting targets for salt reduction that can meet WHO targets.
“We propose a step-wise approach for setting targets for salt levels in foods for LMICs, as the basis for voluntary or mandatory policy interventions,” wrote the team. “The five steps are: (1) identifying the foods which contribute to salt in the diet; (2) agreeing which foods to set targets for; (3) establishing the target levels; (4) stakeholder engagement; (5) establishing monitoring mechanisms.”
They suggested that, as a general rule, targets that aim to reduce population salt intake by 30% in countries where a significant amount of salt in the diet is coming from processed foods mean that there is often a need to reduce salt in processed foods by at least 30%, ‘and even more where possible.’
“However, simply setting a generic target to reduce salt levels in all foods by 30% would not be appropriate given that different product categories have specific requirements,” wrote Downs and her team.
“Examining targets from other countries in relation to the range of products on the national market identified through the shop surveys is a good starting point for LMICs in terms of developing country or region-specific targets for salt levels in food,” they added.
“Moreover, mandatory salt standards adopted in Argentina and South Africa could also be a good starting point, particularly for countries in South America and Africa, respectively.”
Source: Food Policy
Volume 55, August 2015, Pages 101–108, doi: 10.1016/j.foodpol.2015.06.003
“Setting targets for salt levels in foods: A five-step approach for low- and middle-income countries”
Authors: Shauna M. Downs, et al