‘Massive efforts’ are needed to reduce salt intake and protect lives, World Health Organization says

By Janelle Chavez, CNN

The world is off-pace for achieving the goal of reducing sodium intake 30% by 2025, according to a first-of-its-kind report from the World Health Organization.

Although all 194 WHO member countries committed to the target set in 2013, only 5% have implemented comprehensive sodium-reduction policies, according to Thursday’s report.

“Progress has been slow and only a few countries have been able to reduce population sodium intake, but no one has been able to achieve the target,” Dr. Francesco Branca, director of WHO’s Department of Nutrition for Health and Development, said in the report. “As such, it is being considered to extend the target to 2030.”

Sodium is an essential nutrient, but consuming too much increases a person’s risk of heart disease, stroke and premature death, accounting for nearly 2 million deaths around the world each year, according to the Institute for Health Metrics and Evaluation.

The report says the estimated global average salt intake is 10.8 grams per day, more than double the WHO recommendation of less than 5 grams per day in adults.

The report evaluated country implementation of sodium-reduction policies with a “Sodium Country Score Card” ranging from 1 (the lowest level of implementation) to 4 (the highest level).

Only nine countries had a score of 4, meaning they had comprehensive sodium-reduction policies, according to WHO: Brazil, Chile, Czech Republic, Lithuania, Malaysia, Mexico, Saudi Arabia, Spain and Uruguay.

The United States scored 3 out of 4 for having at least one mandatory sodium policy and a declaration of sodium on pre-packaged food. About 22% of the member states had this score.

“We can reduce sodium intake by deciding to add less salt to the food we prepare and by deciding to buy foods that contain less sodium,” Branca said in the report. “However, several public policies need to make this choice an easier one.”

Dr. Tom Frieden says the report “demonstrates that countries must work urgently to implement ambitious, mandatory, government-led sodium reduction policies to meet the global target of reducing salt consumption by 2025.” Frieden is president and CEO of Resolve to Save Lives, a not-for-profit organization working with countries to prevent 100 million deaths from cardiovascular disease over 30 years, as well as former director of the US Centers for Disease Control and Prevention.

“The world needs action, and now, or many more people will experience disabling or deadly — but preventable — heart attacks and strokes.”

Dr. Laura Cobb, director of nutrition policy and surveillance at Resolve to Save Lives, says the US has led successful efforts reducing sodium in mandatory school meal guidelines, and she would like to see expanded national policies.

“The FDA has put into place voluntary targets — not mandatory but voluntary — targets for sodium reformulation,” she said.

The agency says its targets are designed to support decreasing average sodium intake by about 12%, from about 3,400 milligrams per day to 3,000 per day.

“That has the potential to save hundreds of thousands of lives,” Cobb said. “Like any voluntary initiative, whether it’s successful will really depend on how much the US government and others — nonprofits, civil society organizations — really hold industry accountable for that.”

Cobb also says the US has work to do when it comes to food labeling and marketing.

“We don’t have any real comprehensive restrictions on marketing, particularly of unhealthy food. And we certainly don’t have front tables, although it has been discussed,” she said. Front-of-package labels would indicate to consumers which products contain excessive amounts of sodium, sugar and fat.

WHO called on countries to implement interventions related to sodium, including reformulating processed foods to contain less salt, establishing policies to limit sodium-rich foods in public institutions and including front-of-package labeling that helps consumers select products lower in sodium.

Such policies could save an estimated 7 million lives globally by 2030 and reduce sodium intake by over 20%, WHO says, getting close to the target set for 2025.

“I think it’s just really time for countries to step up,” Cobb said. “We hope that this report will be a call to action and that we’ll be able to stop heart disease before it starts.”

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