Although itE
may seem like a harmless part of everyday life, high salt intake contributes to serious health risks that cause millions of deaths each year. This World Salt Awareness Week, we examine the health impacts of excess sodium intake, key sources of sodium in our diets, and an innovative regulatory intervention that can help reduce this “forgotten killer.”

Recommended levels of sodium

Most of the sodium we consume comes from salt. The World Health Organization (WHO) recommends that adults consume less than 2,000 mg of sodium, or 5 grams of salt, per day. This equates to less than one teaspoon of salt. The 2015-2020 Dietary Guidelines for Americans recommended that people aged 14 years and older consume less than 2,300 mg per day.

Globally, and within the United States, the majority of people consume too much sodium. Global average salt intake is estimated at 9 – 12 grams per day, double WHO’s recommended levels. In the United States, adults consume an average of more than 3,400 mg each day. Nearly 90% of US children consume more sodium than recommended.

Key sources of sodium

According to the CDC, more than 75% of sodium consumed by Americans comes from processed, prepackaged, and restaurant foods. More than 40% comes from 10 types of food, including bread, deli meats, pizza, poultry, and pasta dishes. Around 5% of dietary sodium is added during at-home meal preparation and 6% is added to food at the table.

Health impacts of high sodium intake

High sodium intake is a leading risk factor for raised blood pressure, stroke and heart disease. Globally, raised blood pressure causes 9.4 million premature deaths each year. In the US, stroke and heart disease cause more deaths than any other cause. Lowering salt intake helps reduce blood pressure and risk of heart disease and stroke.

Population-level sodium reduction strategies: innovative approaches from Argentina and South Africa

In 2013, the World Health Assembly set a global target to reduce population salt intake by 30% by 2025. Recognizing the health risks and disease burden associated with excessive salt consumption, governments across the globe are taking action to reduce salt intake. Argentina and South Africa have become the first countries to adopt legally binding maximum salt levels across a broad range of processed foods.

In 2014, 38 countries had voluntary and/or legally binding salt content targets for processed foods. South Africa and Argentina have legally binding standards across a broad range of processed foods, including bread, cured meats, soups and stock, and snack foods. An additional 7 countries have legally binding maximum salt levels for at least one product, usually bread.

Many experts believe that mandatory legal requirements are more effective in reducing salt levels than voluntary targets or agreements. Legally binding requirements are preferable because they incorporate penalties for non-compliance. Additionally, voluntary targets are often susceptible to industry influence and subsequent non-compliance.

An initial evaluation of Argentina’s mandatory salt reduction law found median sodium values below the legislative limits in 15 of 18 food groups before the requirements took effect. This suggests that lowering existing maximum salt content requirements and adding new product categories could further reduce consumption. South Africa’s law took effect in June 2016 and ongoing monitoring and evaluation of laws in both countries will further establish feasibility and impact of legally binding requirements.

The mandatory approach adopted in South Africa and Argentina shows great promise to drive much-needed reductions in salt intake. To ensure such laws are effective, government agencies charged with implementing the laws must have the authority, funding, and capacity to monitor compliance, enforce the provisions, and report on achievement of public health outcomes.