Multi-disciplinary researchers suggest sodium reduction targets in China could prevent “1.7 million deaths”

19 Jul 2023 --- Sodium reduction targets of 20% for pre-packaged foods in China have been proposed by researchers in light of their latest findings published in the WHO Bulletin, demonstrating that these products contribute about a third of salt intake in the population.

To set suitable maximum sodium targets, researchers from the Chinese Centre for Disease Control and Prevention, The George Institute for Global Health, Queen Mary University of London and the WHO linked nutrition data from 51,803 pre-packaged food products with food consumption data from 15,670 Chinese adults, recategorizing products based on an adapted version of the WHO framework.

“With pre-packaged foods now making up almost a third of salt intake in China, mandatory salt reduction targets for all key contributors to salt intake are urgently needed to help prevent the estimated 1.7 million deaths attributable to excessive salt intake annually,” says Hattie Burt, senior policy and international projects officer at World Action on Salt, Sugar and Health.

“While consumer-targeted education campaigns still have an important role in China, implementing targets to encourage the food industry to reformulate their products with less salt – one of the simplest and most cost-effective measures a country can take to improve population health outcomes – is vitally needed.”

In March, the WHO stated in a report that the world is off-track in reaching its global target of reducing sodium intake by 30% by 2025, which may jeopardize millions of lives. One gram of sodium is equal to 2.5 g of salt. 

Combating diet-related diseases
The results show that pre-packaged foods contribute to a sodium intake of 1,302.5 mg/d (3.3 g salt) among adults, accounting for 30.1% of the population’s sodium intake. Soy sauce and fish sauce contributed most to sodium intake, followed by ready-to-eat meals and salted butter and spreads.

According to the research, the revised targets, which aim to reduce diet-related disease and death, would result in sodium reduction of 305 mg/d, or 6.1% at a population level in China, a significant step toward achieving the national goal of 20% by 2030. The targets can be lowered gradually toward the WHO benchmarks in the longer term. 

The researchers calculated that if all products in China met the WHO global sodium benchmarks, the sodium intake from pre-packaged food would be reduced by 701.2 mg/d, accounting for a 13.9% reduction in population sodium intake.The proposed reduction should achieve WHO goals for most pre-packaged food subcategories in China.

“Strategies to promote food reformulation for sodium reduction now need to be strengthened, as our study has shown that the contribution of pre-packaged food to salt intake has grown and its market share is increasing,” says Prof. Puhong Zhang, associate director at The George Institute for Global Health.

While the Chinese government’s national salt reduction programs targeting catering and family chefs have markedly reduced household salt use, the 11 g daily population salt intake is still more than twice the WHO recommendation of 5 g daily.

The researchers analyzed the sodium content of pre-packaged foods, their contribution to population sodium intake and the potential impact of various target-setting designs on sodium reduction in China.

Establishing a suitable policy
According to the study, mandatory reformulation generally reduces population-wide salt consumption more than voluntary reformulation. If targets are implemented voluntarily, supportive measures are needed, such as strong government leadership, the threat of government regulation if compliance is low and robust monitoring with the publication of findings. 

Setting maximum sodium targets for pre-packaged foods is an effective strategy to reduce salt intake and has been adopted by around 65 countries. To accelerate the uptake of this policy among its member countries, the WHO developed global sodium benchmarks for various foods in 2021. 

However, this target-setting policy has yet to be officially enacted in China, mainly due to the lack of robust and reasonable sodium targets.

“Considering that harnessing the food industry’s capacity to reduce salt in its products is much easier and more sustainable than changing people’s cooking and dietary behavior, we strongly suggest deepening action on salt by simultaneously implementing sodium target-setting in China,” says Zhang.

The 20% reduction target has been proposed as it would achieve a substantial and acceptable reduction in sodium for most subcategories in China. 

By Inga de Jong