Please see Food and the responsibility deal: how the salt reduction strategy was derailed for more information
In 1994 the Committee on Medical Aspects of Food and Nutrition Policy (COMA) recommended a reduction in salt intake to <6 g/day1. This recommendation was rejected by the Department of Health and the Conservative government in 1996. This led to the setting up of Action on Salt (formerly Consensus Action on Salt and Health (CASH)), a non-governmental organisation with members including most of the leading experts on salt and blood pressure in the UK to try to reverse this decision2,3. As a result, in 2001 Liam Donaldson, chief medical officer, re-endorsed the recommendation made by COMA, and it was agreed with John Krebs, chair of the FSA, that salt reduction would be the first of several pioneering nutritional policies that the FSA would take on4. SACN was then asked to review all the evidence on salt and health.
In 2003 SACN reported that the evidence of salt raising blood pressure was strong, and the FSA formally adopted salt reduction as one of its major nutritional policies4,5. Discussions about how salt intake should be reduced were held with Action on Salt and other organisations. After considerable debate, it was decided that industry should be given voluntary salt targets but that the FSA and non-governmental organisations should be responsible for close monitoring and enforcement of the targets to ensure that all the major food companies would be involved and that they would all aim for the same targets4.
The strategy was to set specific targets (around 10-20%) for the reduction of salt added to each of the 85 categories of food, to be achieved in four years. After two years, meetings would be held with the industry to review progress and set targets for another 10-20% reduction to be achieved two years after the previous targets. This cycle would be continued until the target of 6 g/day of salt intake for the adult population was achieved. This policy of unobtrusive reformulation has the advantage that the public can go on eating the same foods while their salt intake falls.
After extensive discussions with the food industry this policy was accepted, and the first targets were published in 2006 to be achieved by 20106.
At the same time the FSA set up robust mechanisms to measure the effectiveness of their policies—specifically, monitoring the reduction of salt in processed foods and measuring 24 h urinary sodium excretion in a random sample of the population. The salt content of many food products was reduced by around 20-40% in the 7-8 years after the policy was introduced. The reductions were made slowly, with no reported loss of sales by the food industry7. The average salt intake, measured by 24 h urinary sodium in a random sample of the adult population, fell by 15%, from 9.5 g/day in 2003 to 8.1 g/day in 20118. This was accompanied by a fall in population blood pressure and mortality from stroke and ischaemic heart disease9. The FSA and the National Institute for Health and Care Excellence estimated that salt reduction campaigns have prevented around 9000 deaths due to stroke and ischaemic heart disease a year and resulted in annual healthcare savings of around £1.5bn in the UK.
- Health Education Authority. Nutritional aspects of cardiovascular disease. 1994. nice.org.uk/proxy/?sourceUrl=http%3A%2F%2Fwww.nice.org.uk%2Fnicemedia%2Fdocuments%2Fnutritioncardiodisease.pdf.
- Action on Salt www.actiononsalt.org.uk
- MacGregor GA, Sever PS. Salt––overwhelming evidence but still no action: can a consensus be reached with the food industry? CASH (Consensus Action on Salt and Hypertension). BMJ 1996;312:1287-9
- Food Standards Agency. UK salt reduction initiatives. www.food.gov.uk/multimedia/pdfs/saltreductioninitiatives.pdf
- Scientific Advisory Committee on Nutrition. Salt and health. 2003. www.sacn.gov.uk/pdfs/sacn_salt_final.pdf.
- Food Standards Agency. New salt reduction targets published. 21 Mar 2006.http://webarchive.nationalarchives.gov.uk/20120206100416/http://food.gov.uk/news/newsarchive/2006/mar/salttargets.
- Scottish Food and Drink Federation. Highland baker reduces salt content of bread products by 20%.sfdf.org.uk/sfdf/Macleans%20bread_bread_4.pdf
- Department of Health: Assessment of dietary sodium levels among adults (aged 19-64) in England, 2011.gov.uk/government/publications/assessment-of-dietary-sodium-levels-among-adults-aged-19-64-in-england-2011.
- He FJ, Pombo-Rodrigues S, MacGregor GA. Salt reduction in England from 2003 to 2011: its relationship to blood pressure, stroke and ischaemic heart disease mortality. BMJ Open2014;4:e004549