Epidemiologia e prevenzione delle malattie cerebro e cardiovascolari
Epidemiologia e prevenzione delle malattie cerebro e cardiovascolari
WHO has identified reducing salt intake as a priority for preventing non-communicable diseases. Daily salt consumption should be limited to less than 5 grams (corresponding to 2 grams of sodium per day). The WHO Global Action Plan for the prevention of non-communicable diseases recommends a 30% relative reduction in the mean population intake of salt/sodium by 2025 [1].
Reducing salt content in processed food products is not easy to achieve. Traditionally, salt (sodium chloride) is used as a food preservative and as additive to improve food taste (especially in low quality foods) [2]. Over time, all of us have become accustomed to the salty taste of foods, so much so, that less salty foods, in addition to being scarcely available, risk not being appreciated.
To promote and harmonize interventions aimed at cutting salt intake, the WHO Action Network on Salt Reduction in the Population in the European Region (ESAN) was established in 2007. It involves 23 countries [3].
In this context, four key areas of focus to guide national plans of intervention have been identified:
The WHO European Food and Nutrition Action Plan 2015-2020, launched in 2014, underlines these same areas of intervention and includes the reduction of salt consumption among the main objectives [4].
In the last decade, most European countries, including Italy, have undertaken multi-sectoral strategies to reduce salt intake in the population. A large majority of national interventions include industry involvement to reduce the salt contain of processed foods. Bread is the most targeted food for reformulation followed by consumer products such as meat, ready-made foods, salty snacks, sauces, cheese and soups [5,6].
See the summary table of interventions adopted by European countries (pdf 131 kb)
The examples of Finland and the United Kingdom
Finland and the United Kingdom have particularly engaged in initiatives to reduce sodium in food, becoming a point of reference for other countries.
In Finland, health authorities have recommended a reduction in salt consumption since the 1970s and promoted several initiatives to achieve this goal. In addition to numerous awareness-raising campaigns on the benefits of reducing salt intake, a mandatory “warning” label highlighting foods high in sodium content (above pre-established thresholds) and a ‘better choice’ logo highlighting low salt options have been introduced. Consequently, the food companies have voluntarily reduced the average sodium content in their products. Monitoring of sodium excreted in the urine showed that sodium intake decreased by 36% between 1979 and 2007 in the Finnish population [5,7].
In the United Kingdom, the extensive information campaigns carried out from 2004 to 2009, the specification of sodium quantity on food product label, and above all the agreements with food manufacturers which gradually lowered salt content in over 80 product categories, have already led in 2008 to a significant reduction of the sodium content in consumer foods such as: breakfast cereals (-43%), sandwich bread (-30%), ready-made sauces (-30%), canned soups (-25% ), salty biscuits (-45%) [4]. Monitoring of sodium excreted in the urine in the general population showed a 14.7% reduction in salt intake in the United Kingdom between 2001 and 2011 [8,9].
Italy started with less salty bread
As in other European countries, initiatives consistent with WHO recommendations have also been launched in Italy. In 2009 and 2010, the Ministry of Health, within the "Gaining health" program, signed agreements with the representatives of artisan and industrial bakery to gradually reduce salt content in bread up to 15% less by 2011 [10]. This reduction, as demonstrated in clinical studies [11], is practically not perceptible in terms of taste, but is important to prevent many cases of heart attack and stroke. In fact, bread is one of the foods that leads to a higher consumption of sodium during the day: a single slice provides 0.15 g of sodium, but generally people eat several slices per day.
Since 2010, the range of products affected by salt reduction has increased. Several agreements have been signed between the Ministry of Health and food industry associations to reduce salt content in some products such as packaged dumplings, frozen ready first courses, frozen soups and vegetable soups. This action has been reinforced by further measures aimed at reducing sodium content in numerous food products not included in the abovementioned agreements [12]. Furthermore, the reduction of salt consumption is a central objective of the National Prevention Plan (PNP) 2014-2018, extended to 2019, pursued by the Regions through the development of initiatives including, inter alia, local intersectoral agreements, information activities for the population, and training for food industry workers.
As part of the "Minisal-GIRCSI" and "Less salt more health" Ccm projects, salt consumption was estimated in samples of the Italian adult population through 24-hour urine collection. This evaluation was performed within the national survey of the Progetto Cuore ‘Cardiovascular Epidemiological Heart Observatory Project / Health Examination Survey 2008-2012’.
About 10 years later, within the Ccm Project ‘Monitoring of sodium consumption in the Italian population’, inserted in the national survey of the Progetto Cuore ‘Health Examination Survey 2018-2019’, salt consumption has been estimated in representative samples of the Italian adult population by using the same methodology applied in the previous survey. The results, available in 2020, will allow to evaluate the effectiveness of the initiatives undertaken in Italy.
The results of comparison between 2008-2012 and 208-2019 data (13) highlighted a significant reduction in salt consumption in the Italian adult population, encouraging the initiatives undertaken by the Ministry of Health in order to salt intake at the population level through the "Gaining Health: Making Healthy Choices Easy" Program and the National Prevention Plan.
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