IJE Advance Access originally published online on April 7, 2009
International Journal of Epidemiology 2009 38(3):791-813; doi:10.1093/ije/dyp139
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Salt intakes around the world: implications for public health
1 Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, UK.
2 Chronic Diseases and Health Promotion Department, World Health Organisation, Geneva, Switzerland.
* Corresponding author. Professor of Epidemiology and Public Health Medicine, Department of Epidemiology and Public Health, Faculty of Medicine, St Mary’s Campus, Imperial College London, Norfolk Place, London W2 1PG, UK. E-mail: p.elliott{at}imperial.ac.uk
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Abstract |
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Background High levels of dietary sodium (consumed as common salt, sodium chloride) are associated with raised blood pressure and adverse cardiovascular health. Despite this, public health efforts to reduce sodium consumption remain limited to a few countries. Comprehensive, contemporaneous sodium intake data from around the world are needed to inform national/international public health initiatives to reduce sodium consumption.
Methods Use of standardized 24-h sodium excretion estimates for adults from the international INTERSALT (1985–87) and INTERMAP (1996–99) studies, and recent dietary and urinary sodium data from observational or interventional studies—identified by a comprehensive search of peer-reviewed and ‘grey’ literature—presented separately for adults and children. Review of methods for the estimation of sodium intake/excretion. Main food sources of sodium are presented for several Asian, European and Northern American countries, including previously unpublished INTERMAP data.
Results Sodium intakes around the world are well in excess of physiological need (i.e. 10–20 mmol/day). Most adult populations have mean sodium intakes >100 mmol/day, and for many (particularly the Asian countries) mean intakes are >200 mmol/day. Possible exceptions include estimates from Cameroon, Ghana, Samoa, Spain, Taiwan, Tanzania, Uganda and Venezuela, though methodologies were sub-optimal and samples were not nationally representative. Sodium intakes were commonly >100 mmol/day in children over 5 years old, and increased with age. In European and Northern American countries, sodium intake is dominated by sodium added in manufactured foods (
75% of intake). Cereals and baked goods were the single largest contributor to dietary sodium intake in UK and US adults. In Japan and China, salt added at home (in cooking and at the table) and soy sauce were the largest sources.
Conclusions Unfavourably high sodium intakes remain prevalent around the world. Sources of dietary sodium vary largely worldwide. If policies for salt reduction at the population level are to be effective, policy development and implementation needs to target the main source of dietary sodium in the various populations.
Keywords Salt, sodium, dietary, urinary, blood pressure, cardiovascular disease prevention
Accepted 12 January 2009
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