Research for Salt Awareness Day shows older people benefit most from reductions in salt, but are also most confused about salt in food

26th January - Salt Awareness Day 2005

CASH uses House of Commons event to call on UK food industry to do more to prevent deaths from stroke and heart attack.

Calculations by Consensus Action on Salt and Health, to coincide with their 6th National Salt Awareness Day on January 26th, show that people over the age of 60 who reduce their salt intake to the recommended 6g per day can reduce their risk of a stroke by up to 31% and their risk of a heart attack by up to 24% in a matter of days. [1]
However, research by CASH shows that only 13% of patients referred to the Blood Pressure Unit at St George’s Hospital were managing to eat less than 6g of salt per day, despite believing that they were cutting down on their salt intake, or in some cases thinking they were eating no salt at all. [2].
This total confusion over salt intake is largely explained by a survey of older people, carried out by CASH, which showed that almost seven out of ten of those questioned (69%) said they found current food labelling of sodium incomprehensible [3].  63% did not know the relationship between salt and sodium, with only a third (33%) aware that salt contains sodium.  By comparison, 67% of MPs and 71% of teachers who were asked the same question last year at least knew that salt contains sodium.
“Older people will have dramatic reductions in strokes and heart attacks if they cut their salt intake to the recommended levels. They are at greater risk and will have immediate and larger falls in blood pressure,” says Professor Graham MacGregor, Chairman of CASH.  “We found that individuals who tell us they eat no salt at all are in fact consuming well over 6g per day. This is because they do not understand that 80% of the salt they eat is hidden in processed, fast, canteen and restaurant food.

“Many of our patients make a big effort to stop adding salt to their cooking and at the table, but they don’t realise for instance that cornflakes contain as much salt as sea water or that bread is the source of around a quarter of our salt intake.   This is compounded by the fact that the majority of foods are not labelled with their salt content.”
Indeed, 75% of the older people surveyed failed to pick a portion of cornflakes as the saltiest food in a list of four options.
“We need the food industry to support older people in their attempts to cut down on salt.  Firstly, the whole of the food industry must immediately cut the unnecessarily high levels of salt that they add to our foods.  At the same time they must immediately start to label clearly the salt content of all their products" continues Professor MacGregor. “The Co-op has led the way on salt labelling and we urge all other retailers and manufacturers and all sections of the food industry that add salt to food to follow their example.  
“We are talking about preventing a minimum of 70,000 strokes and heart attacks (35,000 of which would be fatal) if the whole UK population could reduce their salt intake to the recommended levels.  In public health terms, this is as important for saving lives as the introduction of clean water and drains was in the 19th century.”

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[1] These calculations of reduction in risk for older people are based on two papers published in the Lancet (Cappuccio et al. Lancet 1997;350:850-854, and Prospective Studies Collaboration Lancet 2002:360:1903-1913).

The first paper is a randomised double-blind salt reduction trial in older individuals (average age: 67 years). From this study we estimated that a reduction of 6g/day in salt intake (e.g. from the current intake of 12g/day to the recommended level of 6g/day) would cause a fall in systolic blood pressure of 8.7 mmHg in the older population.

The second paper is a meta-analysis of one million adults in 61 prospective studies looking at the relationship between blood pressure and cardiovascular risk. With the information on systolic blood pressure from this meta-analysis, we calculated the reductions in stroke and ischaemic heart disease that would occur with a fall in systolic of 8.7 mmHg in the older population.

[2] 23 patients over the age of 50 were surveyed in this pilot study.  All had been referred to the Blood Pressure Unit at St George’s Hospital and claimed to be cutting down on salt or eating no salt at all.   Their actual salt intake was measured by 24-hour urine collection.  Of the 23 patients, only 3 (13%) had a salt intake of less than 6g.  Salt intakes varied from 3.7g to 23.7g, with the average salt intake being 9.3g.  7 of the 23 patients had salt intakes of over 10g per day. A summary of this study is attached below.

[3] 103 people over the age of 50 were interviewed by CASH in September 2004.  47% of the participants were women and 53% were men.  A summary of the research results is attached below.
Notes to editors:
• Consensus Action on Salt and Health (CASH) is a group of the UK’s leading experts on salt and its effects on health.  It is working to reach a consensus with the food industry and government over the harmful effects of a high salt diet, and bring about a reduction in the amount of salt in processed foods as well as salt added to cooking and at the table, so that salt intake in the UK is reduced in adults to less than 6g a day.
• Graham MacGregor is Professor of Cardiovascular Medicine at St George’s Hospital Medical School in Tooting, London.
• CASH holds Salt Awareness Day each year with a reception at the House of Commons.  Speakers at Wednesday’s event will be Melanie Johnson, Public Health Minister; Sir John Krebs, Chair of the Food Standards Agency; Barbara Gill, Chair of the Women’s Institute and Professor Graham MacGregor, Chair of CASH.  The event will be chaired by Debra Shipley MP.
Further background:
Survey in the older population for Salt Awareness Day 2005

The theme for this year’s 6th National Salt Awareness Day is salt and the older population.  In light of this we conducted a pilot study to find out what the older population understand about salt and any misconceptions that they may have.

The aim of the pilot was to explore older people’s perceptions of salt and salt labelling, thus leading to a fuller investigation at a later date.

The survey was conducted in September 2004 at a London Pensioners Fund Conference and the Nutrition and Health Show.   It used an interviewer-administered questionnaire which attendees were asked to fill in and hand back once completed.

A total of 103 people were surveyed: 28% (50-59 yrs), 28% (60-69 years), 27% (70-79 years), 5% (80-89 years), 2% (90+) and 10% that did not report their age.
There was an approximately equal distribution of men and women, 47% and 53% respectively.

Key findings

• Nearly all (95%) knew that salt causes blood pressure to rise.

• Only 1 in 5 knew that salt is linked with osteoporosis (18%) and stomach cancer (19%).

• One in four (26%) either did not know how much salt they should be eating in a day or got the figure wrong.

• Only 70% of the older people surveyed were aware that the majority of salt comes from processed foods, compared to 100% of MPs, 89% of health professionals and 87% of teachers who were asked the same question in last year’s research.

• The majority of participants were unaware of hidden salt levels in four given foods. 75% did not know that cornflakes were the saltiest of the four products.

• Only 33% of the older population are aware that salt contains sodium.  This compares to 67% of MPs, 71% of teachers and 68% of health professionals asked the same question last year.

• Almost two in three 63% did not know the relationship between sodium and salt or got it wrong. There is a definite lack of understanding and knowledge about the difference between salt and sodium as 24% said that salt and sodium were exactly the same and 22% had no idea about the relationship between salt and sodium.

• The majority of respondents (69%) said that present sodium information on labels is not comprehensible.

• 81% of respondents would like to see salt labelled in one of two formats, either with salt content per serving or just the salt content

For a copy of the full survey findings, please contact us at

CASH study October/November 2004: 24 hour sodium urine analysis (n=23)

As part of our focus on older people for Salt Awareness Day 2005, we wanted to ascertain whether people motivated to reduce their salt intake for health reasons were managing to keep below the 6g per day limit.

We therefore recruited 23 patients (17 men and 6 women) with hypertension who had been referred to the Blood Pressure Unit at St George’s Hospital.  At their first appointment all stated that they were cutting down their salt for the sake of their health or that they were eating no salt at all.

Their sodium intake was measured from 24-hour urine collection and the results showed that only 13% (3/23) of these patients actually had a salt intake of less than 6g per day.  One participant had a salt intake of 23.7g – almost four times the recommended limit.

The results of this study are worrying in that it appears that the message that salt is hidden in processed food is simply not getting through to older people, even those who know that they need to reduce their salt intake because they have raised blood pressure.  These patients had cut down on - or cut out – the salt they added to their food in cooking and at the table, but were unaware of the level of salt in ready-made foods.