Two NEW studies have examined the impact of the UK's salt reduction programme, and the improvements needed to ensure the programme continues to be successful. The first study (Socioeconomic status and dietary sodium intake in children from 2008 to 2019 in the United Kingdom) published on 22nd June 2022 in the Journal of Hypertension suggests that the UK's salt reduction programme can help reduce health inequality by benefitting all population groups, particularly the more socially deprived who are at greater risk of developing high blood pressure, stroke and heart disease.

Given little is known about whether children's salt intake has been affected by efforts to reduce population salt consumption in the UK, researchers at Queen Mary University of London assessed the trend of salt intake among 6,281 children (aged 4 - 18 years) from different socioeconomic backgrounds in the UK from 2008 to 2019.

Using data from the National Diet and Nutrition Survey, salt intakes reported in children (mean age 11.0±4.3 years) were 5.1g/day¹ as assessed by 4-day dietary record in 2008/09-2011/12, and decreased to 4.2g/day by 2016/17-2018/19, with the greatest reduction occurring in lower occupation families².

The study also demonstrated socioeconomic inequalities in salt intake with an inverse association between household occupation and salt intake. For example, in 2008/09-2011/12, children from lower occupation families consumed significantly more salt (109.6 ±23.1mg sodium per day (P<0.001) – equivalent to 0.27g salt) – than those from higher occupation families. This difference decreased over time and was no longer significant in 2016/17-2018/19, indicating a greater impact of the UK's salt reduction programme in those from lower socioeconomic backgrounds.

The UK's Salt Reduction Programme
The second study (Salt: The Forgotten Foe in Public Health Policy), an analysis also published 22nd June 2022 in the BMJ, has highlighted how the UK's once pioneering voluntary salt reduction programme is in need of a major shake up to keep pace with newer, mandatory measures implemented in other countries – to date, 19 countries have mandatory salt reduction targets.

In the early 2000s, the UK implemented a voluntary salt reduction programme closely-managed by the Food Standards Agency, which involves collaborating with the food industry to gradually reduce the amount of salt added to processed foods. At the height of its success, salt intake fell by 15% in the adult population, with subsequent falls in blood pressure. This prevented 9,000 deaths from stroke and heart attacks a year, as well as generating annual cost savings of £1.5 billion for the NHS³.

However, when responsibility for salt reduction moved from the Food Standards Agency to the Department of Health, the voluntary policy with industry stopped working. Salt intake has not fallen since that early success, and at 8.4g/day is 40% higher than the maximum recommended limit of 6g/day. The BMJ analysis highlights that this is a direct consequence of inconsistent government leadership, no penalties for the food industry if they do not comply with salt reduction targets, and salt reduction falling down the priority list with the current policy focus on obesity.

Authors of the BMJ article highlight several important measures that are now needed: starting with mandatory salt reduction targets and supported by effective and transparent monitoring, and front of pack labels across all products to reveal their high salt content.

Medical student at Queen Mary University of London and first author of the Journal of Hypertension study, Ms Yiu Lam Cheng explains: "By gradually reducing the large and unnecessary amounts of salt added to all processed food, this could potentially help reduce health inequalities among socioeconomic groups. Given that reducing salt intake has been identified by the World Health Organisation as one of the most cost-effective measures to improve population health, the UK’s food industry should be leading by example rather than lagging behind."

Hattie Burt, Policy and Communications Officer at Action on Salt and first author of the BMJ Analysis, says: "The pandemic and a multitude of other factors has put the NHS under extraordinary strain. The NHS cannot prevent the huge health impact of excess salt in our diets – but the government can. We are calling on Health Secretary Sajid Javid to include regulatory measures to tackle the huge and unnecessary amounts of salt added by the food industry in the Health Disparities White paper expected next month."

Professor Graham MacGregor, Professor of Cardiovascular Medicine at Queen Mary University of London, Chairman of Action on Salt and co-author of the studies says: "Reducing salt is the most cost-effective measure to lower blood pressure, cut the number of people dying and suffering from strokes and heart disease and importantly to reduce health inequalities, yet the food industry continue to pack our food with unnecessary salt. The Government now needs to stop the food industry adding excessive amounts of salt to our food and force the industry to ensure that salt reduction targets are met. Thousands of strokes and heart disease events will be prevented."

1. The terms sodium and salt are often used interchangeably. However, on a weight basis, salt comprises 40% sodium and 60% chloride. 1 g sodium=2.5 g salt. Salt is the major source of sodium in the diet (≈90%)
2. Higher, intermediate and lower occupation families follows the National Statistics Socio-economic Classification (NS-SEC) where 'higher occupation' refers to higher managerial, administrative and professional occupations; 'intermediate occupation' refers to non-supervisory positions such as clerical, sales and service; and 'lower occupation' refers to routine and manual occupations e.g. operative, agricultural and production