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Global Salt InitiativesFrom Evidence to Worldwide Implementation Graham A MacGregor Major Underlying Factors Causing Death - Worldwide Systolic BP and Risk of Death Atheroma in carotid artery What puts up population BP? Salt intake Lack of fruit and vegetables Weight Lack of exercise (Alcohol excess) Salt Evidence Epidemiology Over 50 population studies and Intersalt Migration e.g. Kenya Intervention Portuguese villages. New born babies Genetic All defects impair ability of the kidney to excrete Na Mechanisms Plasma Na, corrected volume expansion Animal BP caused or aggravated by salt (e.g. chimpanzees) Treatment Trials, Meta-analysis. Dose response Mortality studies Finland (24h UNa) Outcome trials TOHP, Taiwan (mineral salt: high K, low Na) ? salt intake 6g/day USA 150,000 (approx) deaths prevented / year Worldwide 2.5 million (approx) Stroke Heart attack deaths prevented / year Summary Hidden Salt – Its Commercial Value Sea Water Comparison (1.0 g of sodium / 2.5g of salt per 100g) Pizza 60% Chicken Curry 60% Processed Cheese 130% Bacon 200% Sausages 100% Smoked Fish 190% Sweet Pickle 170% Shepherds Pie 40% Frozen Prawns 80% Crisps 110% Salad Cream 100% Savoury Biscuits 70% Action in the UKConsensus Action on Salt Health Change Department of Health policy Ensure Food Standards Agency adopted salt reduction labeling Media publicity to the public and food industry Persuade retailers and food company’s to reduce salt added to food Food Standards Agency (UK) Set up to deal with BSE – New variant CJD What else? – salt reduction Target set for levels of salt in key product categories 2006 Traffic Light Label GDA Label Actions so far Most processed foods have or will be reduced by 20-30% by 2010 More challenging targets have been set to be achieved by 2012 Foods eaten outside the home are now being addressed (e.g. canteens, restaurants, fast foods, takeaways, etc.) Aim: To reduce salt intake to less than 6 g/d (adults) by 2012 Success so far UK Wo