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Most of the worldâÂÂs population eats more salt than required, and there is strong scientific basis to believe that this is causing large adverse effects. Globally, 12.90 million people die of heart attack every year with 2.68 million in China and 1.74 million in India. High blood pressure, a major cause of heart attacks, is caused by high salt intake. Reduction is the daily intake of salt is one of the best ways for prevention of non-communicable diseases in low and middle-income countries without any adverse impact on the general health of the people. Just 1.0g lower salt intake reduces the risk of heart attack and stroke by 4.8%. Most salts are consumed as packaged or restaurant foods while a chunk of salts are added during food preparation and consumption, 10% are naturally occurring. Not much can be done about naturally occurring salts, 90% use of discretionary salt is preventable.

Science has it that salt was scarce for most hominid evolution with no adverse health consequences and was first manufactured some 6,000 years ago for a few hundred people. Several studies carried out in the developing countries, including 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), and cancers , especially among urban population causing 70% of the deaths in the world as per the Global Burden of Disease report.

Raised blood pressure is one of the leading risk factors for global mortality and is estimated to have caused 9.4 million deaths and 7% of disease burden â as measured in DALYs â in 2010. A large number of risk factors for DALYs are nutrition-related. India is particularly hard hit. The prevalence of raised blood pressure in India is around 26 percent and is considered to be a leading cause of death, stroke, myocardial infarction, congestive heart failure, and chronic renal impairment. About 1 in 3 of all adult Indians have high blood pressure, by itself making it a major public health burden. According to the Global Burden of Disease Study 2015, approximately 3750 years of life were lost per lakh population in 2015 due to ischemic heart disease, representing more than 20% increase from 2005.  Five out of the top 10 causes of deaths in India are now due to NCDs. What is more alarming is the inexorable rise in the contribution of NCDs to all deaths, presenting a challenge for health community.

While national and international guidelines have called for reductions in average sodium intakes at the population level to tackle the population-wide burden of high blood pressure levels and the associated cardiovascular risks, much still needs to be done on ground. The report of a joint World Health Organization (WHO) and Food and Agriculture Organization (FAO) Expert Consultation recommended that adults consume less than 85 mmol/day (<2g/day) of sodium, equivalent to 5 g of salt daily. Reducing salt intake is identified as one of the most cost effective strategies (âÂÂbest buysâÂÂ) in the global action plan for the prevention and control of NCDs.

Keeping this scenario in mind, the recently concluded first-of-its-kind Salt Summit called for measures from the government, food manufacturers, private sector, restaurants, street vendors, cafeteria managers, housewives, civil society and academic and research community to reduce the use of salt. This can be done by mandatory pack labeling, mentioning sodium content targets for food, requiring salt, fat, calorie content display in restaurant menu board and a gradual reduction in salt content of chutneys and junk foods by vendors.

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.

The World Health Organization has established that salt consumption should not exceed 5 g of salt (2.3 g of sodium) per person per day.   In 2010, global mean sodium intake was 3.95âÂÂg/day. This was nearly twice the WHO recommended limit of 2âÂÂg/day and equivalent to 10.06 g/day of salt. Intake in men was 10% higher than in women. A recent meta-analysis showed.  It is worth pointing out that the 30% reduction in mean population salt consumption by 2025 target adopted by the WHO member states will still leave the salt consumption substantially higher than the recommended daily salt intake, suggesting the need to identify effective strategies. 

Sodium (salt) intake is reported to be a modifiable determinant of raised blood pressure. While in the United States and many Western countries, packaged foods eg bread, or chips are the main source of salt, in India, it is salt used in cooking and at the table that is the biggest source of dietary salt. A recent meta-analysis of several studies undertaken in India to estimate salt intake over the past three decades found that the overall mean weighted salt intake among Indians was 10.98 g/day. 

In earlier generations, Indians did hard labor in the fields or walked long distances even in urban India.  The high amounts of salt consumed were excreted in perspiration.  Now with millions migrating to urban settings, driving in to work, or sitting in air-conditioned offices all day long, the amount of salt consumed in everyday food is too much. âÂÂRaised blood pressure is one of the leading risk factors for global mortality and is estimated to have caused 9.4 million deaths and 7% of disease burden â as measured in DALYs â in 2010,â says Dr Vivekanand Jha, Executive Director, George Institute for Global Health.

The prevalence of raised blood pressure in India is around 26 percent and is considered to be a leading cause of death, stroke, myocardial infarction, congestive heart failure, and chronic renal impairment. âÂÂAbout 1 in 3 of all adult Indians have high blood pressure, by itself making it a major public health burden. Five out of the top 10 causes of deaths in India are now due to NCDs. What is more alarming is the inexorable rise in the contribution of NCDs to all deaths, presenting a challenge for health community,â Dr. Jha adds.

Some of the common Indian food items with high salt content include pickles, papads, street food, junk food like namkeen, chips, and chinese food.  Further, street foods in India are not regulated, and many people eat home cooked food.  Thus, food labeling has some challenges in the Indian context. 

In India, we need to dispassionately examine the scientific evidence behind the need for salt reduction, learn from the strategies that have worked in other countries, and work collaboratively with multiple sectors to make change.  

It has been reported that 75 countries have a national salt reduction strategy in place, more than double the number reported in 2010. The majority of programs are multifaceted and include industry engagement to reformulate products, establishment of sodium content targets for foods, consumer education, front-of-pack labeling schemes, taxation on high-salt foods and interventions in public institutions. Legislative action related to salt reduction such as mandatory targets, front of pack labeling, food procurement policies and taxation have been implemented in 33 countries. 12 countries have reported reductions in population salt intake, 19 reduced salt content in foods and 6 reported improvements in consumer knowledge, attitudes or behaviors relating to salt.”