Early Evidence for the Effectiveness of South Africa’s Legislation on Salt Restriction in Foods: the African-PREDICT Study
New research by MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa (published in the Journal of Hypertension) suggests mandatory salt reduction targets are an effective approach to reducing population salt intakes and improving outcomes of strokes and heart disease (i.e. cardiovascular disease / CVD). With the UK currently lagging behind in salt reduction, this much welcomed study demonstrates the success of comprehensive, mandatory salt reduction targets, particularly for vulnerable groups who are at high risk.
The African-PREDICT study determined changes in average salt intake (using 24-hour urinary sodium excretion over a 4.56-year period. This spanned a time before and after mandatory salt reduction targets were implemented in South Africa.
Overall, there was a significant reduction of approximately 1.2g salt per day, including in young adults. The salt reduction was higher in black adults (-2.04g salt per day) and low socio-economic groups (-1.89g salt per day) who were at a high risk of developing CVD and hypertension.
CVD is the leading cause of death globally with 18.6 million deaths in 2019[1]. Salt has been shown to be the highest risk factor with the Southern Sub-Saharan African region consuming approximately 8g per day, similar to the UK’s 8.4g per day, and far exceeding the World Health Organisation recommendation of less than 5g per day.
South Africa was one of the first countries to implement mandatory regulation on sodium (salt) reduction targets in 2016[2]. Due to the excessive sodium consumption in young adults in South Africa, salt reduction was predicted to hugely benefit the prevention of the long-term impact of CVDs such as strokes and heart disease. It was previously estimated that mandatory salt reductions for bread, margarine, soup and seasonings would lead to a 0.85g reduction in salt intake per person per day and prevent around 7,400 CVD-related deaths per year. Thus, the finding of ~1.9 g/day reduction in salt intake in lower socio-economic groups suggests markedly larger beneficial health and economic outcomes.
Consumers do not generally know where the salt comes from in their diet, as around 75% of it is hidden in the foods we already buy and eat, not just in crisps and ready meals but in staple foods such as bread, sauces, soups and takeaways. This salt cannot be removed by the consumer, so simply telling people to eat less does not work. Therefore, it is vital to implement mandatory reformulation policies to lower dietary salt intake in addition to policies targeting consumer behaviour. These findings show effectiveness of sodium reduction policies at a population level, as we are already seeing how the UK is falling behind, despite a two-decades long voluntary salt reduction programme.
Comparisons of salt reductions in similar products in South Africa vs the UK, and percentage difference between the higher and lower product;
Graham MacGregor, Professor of Cardiovascular Medicine at Queen Mary University of London, and Chairman of Action on Salt, comments:
“Salt reduction is one of the most cost-effective strategies to remove unnecessary strokes and heart disease. Many thousands of lives in South Africa will now be saved from strokes and heart disease because of a simple piece of legislation forcing food manufacturers to put less salt in the food that they produce. It has taken the UK 20 years to see similar salt reductions from a voluntary approach, that South Africa has achieved in just few short years with a regulatory approach.
“The UK led the world in reducing salt but due to government inaction, the country is now lagging behind, meaning many thousands of people are dying and suffering unnecessarily. The UK government must now stop pretending that the profit-driven food industry will police itself and set new mandatory comprehensive salt reduction targets immediately.”
ENDS
National PR – David Clarke: david@rock-pr.com M: 07773 225516
Website www.actiononsalt.org.uk
Notes to editors:
About Action on Salt
Action on Salt is a group concerned with salt and its effects on health, supported by 22 expert scientific members. Action on Salt is successfully 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.
Up to 2011, the UK salt reduction programme, under the Food Standards Agency (FSA), led the world and had already saved 18,000 strokes and heart attacks per year – with £1.5 billion a year in NHS healthcare saving costs, according to NICE.
On 7th September 2020 PHE published a new set of voluntary salt targets for industry to achieve by 2024. However, setting targets without enforcement has been shown to have little effect, as demonstrated by the failed Responsibility Deal and the lack of progress made by the food industry on the previous set of targets. What is required is a clear and transparent monitoring programme, to include annual progress reports and strong engagement with the whole sector, along with case studies of successful reformulation to aid industry-wide reformulation
References
[1] https://www.sciencedirect.com/science/article/pii/S0735109720377755
[2] Categories of food including bread, breakfast cereal, butter/margarine, potato crisps, savoury snacks, raw sausage, processed meat, instant noodles, dry soup powder and stock cubes were given targets to reduce the amount of salt added, or a penalty would have to be paid to the South African government.
