Joseph Alvin Santos1, Briar McKenzie2, Emalie Rosewarne2, Martyna Hogendorf2,3, Kathy Trieu2, Mark Woodward2,4, Laura K Cobb5, Rebecca Dodd2, Jacqui Webster2. 1. The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia. jsantos@georgeinstitute.org.au. 2. The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia. 3. Independent Nutrition Consultant, Geneva, Switzerland. 4. The George Institute for Global Health, School of Public Health, Imperial College, London, UK. 5. Resolve to Save Lives, an Initiative of Vital Strategies, New York, USA.
Abstract
PURPOSE OF REVIEW: The objective of this review was to consolidate available published information on the implementation and evaluation of salt reduction interventions in low- and middle-income countries (LMICs). RECENT FINDINGS: The Science of Salt database (made up of studies identified in a weekly Medline search) was used to retrieve articles related to the implementation of salt reduction interventions from June 2013 to February 2020. Studies that measured the effects of the interventions in LMICs, based on four outcome measures-salt intake; sodium levels in foods; knowledge, attitudes, and behaviours (KABs) towards salt; and blood pressure-were included. Results were summarised overall and according to subgroups of intervention type, duration, sample size, country's income class, and regional classification. The review identified 32 studies, representing 13 upper middle-income and four lower middle-income countries. The main salt reduction interventions were education, food reformulation, and salt substitution; and many interventions were multi-faceted. More studies reported a positive effect of the interventions (decreased salt intake (12/17); lower sodium levels in foods or compliance with agreed targets (6/6); improved KAB (17/19); and decreased blood pressure (10/14)) than a null effect, and no study reported a negative effect of the intervention. However, many studies were of small scale and targeted specific groups, and none was from low-income countries. Consumer education, food reformulation, and salt substitution, either alone or in combination, were effective in their target populations. Supporting scale-up of salt reduction interventions in LMICs is essential to cover broader populations and to increase their public health impact.
PURPOSE OF REVIEW: The objective of this review was to consolidate available published information on the implementation and evaluation of salt reduction interventions in low- and middle-income countries (LMICs). RECENT FINDINGS: The Science of Salt database (made up of studies identified in a weekly Medline search) was used to retrieve articles related to the implementation of salt reduction interventions from June 2013 to February 2020. Studies that measured the effects of the interventions in LMICs, based on four outcome measures-salt intake; sodium levels in foods; knowledge, attitudes, and behaviours (KABs) towards salt; and blood pressure-were included. Results were summarised overall and according to subgroups of intervention type, duration, sample size, country's income class, and regional classification. The review identified 32 studies, representing 13 upper middle-income and four lower middle-income countries. The main salt reduction interventions were education, food reformulation, and salt substitution; and many interventions were multi-faceted. More studies reported a positive effect of the interventions (decreased salt intake (12/17); lower sodium levels in foods or compliance with agreed targets (6/6); improved KAB (17/19); and decreased blood pressure (10/14)) than a null effect, and no study reported a negative effect of the intervention. However, many studies were of small scale and targeted specific groups, and none was from low-income countries. Consumer education, food reformulation, and salt substitution, either alone or in combination, were effective in their target populations. Supporting scale-up of salt reduction interventions in LMICs is essential to cover broader populations and to increase their public health impact.
Entities:
Keywords:
Low- and middle-income countries; Noncommunicable diseases; Salt intake; Salt reduction
Authors: Norm R C Campbell; Paul K Whelton; Marcelo Orias; Richard D Wainford; Francesco P Cappuccio; Nicole Ide; Bruce Neal; Jennifer Cohn; Laura K Cobb; Jacqui Webster; Kathy Trieu; Feng J He; Rachael M McLean; Adriana Blanco-Metzler; Mark Woodward; Nadia Khan; Yoshihiro Kokubo; Leo Nederveen; JoAnne Arcand; Graham A MacGregor; Mayowa O Owolabi; Liu Lisheng; Gianfranco Parati; Daniel T Lackland; Fadi J Charchar; Bryan Williams; Maciej Tomaszewski; Cesar A Romero; Beatriz Champagne; Mary R L'Abbe; Michael A Weber; Markus P Schlaich; Agnes Fogo; Valery L Feigin; Rufus Akinyemi; Felipe Inserra; Bindu Menon; Marcia Simas; Mario Fritsch Neves; Krassimira Hristova; Carolyn Pullen; Sanjay Pandeya; Junbo Ge; Jorge E Jalil; Ji-Guang Wang; Jiri Wideimsky; Reinhold Kreutz; Ulrich Wenzel; Michael Stowasser; Manuel Arango; Athanasios Protogerou; Eugenia Gkaliagkousi; Flávio Danni Fuchs; Mansi Patil; Andy Wai-Kwong Chan; János Nemcsik; Ross T Tsuyuki; Sanjeevi Nathamuni Narasingan; Nizal Sarrafzadegan; María Eugenia Ramos; Natalie Yeo; Hiromi Rakugi; Agustin J Ramirez; Guillermo Álvarez; Adel Berbari; Cho-Il Kim; Sang-Hyun Ihm; Yook-Chin Chia; Tsolmon Unurjargal; Hye Kyung Park; Kolawole Wahab; Helen McGuire; Naranjargal J Dashdorj; Mohammed Ishaq; Deborah Ignacia D Ona; Leilani B Mercado-Asis; Aleksander Prejbisz; Marianne Leenaerts; Carla Simão; Fernando Pinto; Bader Ali Almustafa; Jonas Spaak; Stefan Farsky; Dragan Lovic; Xin-Hua Zhang Journal: J Hum Hypertens Date: 2022-05-17 Impact factor: 2.877