Review

Journal of Human Hypertension (2009) 23, 363–384; doi:10.1038/jhh.2008.144; published online 25 December 2008

A comprehensive review on salt and health and current experience of worldwide salt reduction programmes

F J He1 and G A MacGregor1

1Blood Pressure Unit, Cardiac and Vascular Sciences, St George's, University of London, London, UK

Correspondence: Dr F He, Blood Pressure Unit, St George's, University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK. E-mail: fhe@sgul.ac.uk

Received 15 August 2008; Revised 31 October 2008; Accepted 2 November 2008; Published online 25 December 2008.

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Abstract

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Raised blood pressure (BP), cholesterol and smoking, are the major risk factors. Among these, raised BP is the most important cause, accounting for 62% of strokes and 49% of coronary heart disease. Importantly, the risk is throughout the range of BP, starting at systolic 115mmHg. There is strong evidence that our current consumption of salt is the major factor increasing BP and thereby CVD. Furthermore, a high salt diet may have direct harmful effects independent of its effect on BP, for example, increasing the risk of stroke, left ventricular hypertrophy and renal disease. Increasing evidence also suggests that salt intake is related to obesity through soft drink consumption, associated with renal stones and osteoporosis and is probably a major cause of stomach cancer. In most developed countries, a reduction in salt intake can be achieved by a gradual and sustained reduction in the amount of salt added to food by the food industry. In other countries where most of the salt consumed comes from salt added during cooking or from sauces, a public health campaign is needed to encourage consumers to use less salt. Several countries have already reduced salt intake, for example, Japan (1960–1970), Finland (1975 onwards) and now the United Kingdom. The challenge is to spread this out to all other countries. A modest reduction in population salt intake worldwide will result in a major improvement in public health.

Keywords:

salt, health, salt reduction programmes

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