Every year a World Salt Awareness Week is held in March to remind the world of the harmful effects of eating too much salt and highlighting the amount of salt present in everyday foods.

People are encouraged to play their part and make simple changes to their eating and purchasing habits. There are five ways to sticking to five grams – through simple actions one can take to lower to safer levels the salt intake of the whole family.

High levels of dietary sodium intake are associated with raised blood pressure and cardiovascular disease. Furthermore, a high salt diet may have direct harmful effects, independent of its influence on blood pressure, for example, by increasing the risk of stroke, heart size and renal disease. Increasing evidence also suggests that salt intake is related to obesity, is associated with renal stones and osteoporosis and is probably a major cause of stomach cancer.

Various studies have shown that salt intake around the world is well in excess of physiological needs both in children and adults. A study on sodium intake showed that salt consumed in European and North American countries was dominated by sodium added in manufactured foods (75 per cent of intake).

Cereals and baked goods were the single largest contributor to dietary sodium intake in UK and US adults. In Japan and China, salt added at home (in cooking and at the table) and soy sauce were the largest sources.

The World Health Organisation recommends an intake of no more than five grams of salt per day. Unfortunately, the current daily salt consumption in most European countries is estimated to range between eight to 12 grams per day, with few Member States above and few below this intake level.

Current salt consumption patterns are leading to 80 per cent of all deaths

In Malta, there is very limited data. In fact, the current salt intake in Malta is unknown. However, the 1986 Intersalt Study found that Maltese men consumed 11g per day and women consumed nine grams per day. The 2002 Health Interview Survey conducted in Malta showed that 47 per cent of the participants added salt to their meals while cooking, whereas 23 per cent added salt upon eating.

In the Health Interview Survey of 2008, 22 per cent of the population aged over 18 self-reported hypertension. However, the burden is much higher, especially in patients above the age of 40.

In fact, the 2010 European Health Examination Survey reports that 46 per cent of patients aged 41-60 were classified as having possible hypertension, while 85.5 per cent of patients aged 60 have been classified as being possibly hypertensive. An ongoing National Food Consumption Survey gives a good picture of the food and beverage consumption patterns locally, including that of salt.

The impact of increased salt consumption has been defined as a critical issue by the WHO and by the European Commission. All Member States are encouraged to tackle this issue immediately as the current salt consumption patterns are leading to 80 per cent of all deaths. Reducing salt intake can make a difference. It was found that reducing salt by five grams a day will result in a 23 per cent decrease in stroke cases and 17 per cent decrease in cardiovascular disease cases. A small reduction in blood pressure of 1-4 mmHg showed a reduction of cardiovascular deaths by five to 20 per cent.

Malta has joined the EU initiative to reduce salt in order to reduce the burden of illness. Various initiatives have already been initiated, targeting the public to increase awareness on the effects of salt on health, to read labels and to enhance skills in using alternative products in cooking. Work has also been initiated with industry to encourage the reduction of salt.

Many people think that their salt consumption levels are low but one will be surprised to know about foods that have a high salt content. Salt is naturally present at low levels in all foods but around 80 per cent of our salt intake is hidden in processed food.

Salt is mostly present in everyday foods such as bread, cheese and sauces, so most of us are eating too much salt without even knowing. Some foods that are high in salt don’t taste particularly salty. Breakfast cereals, bread, jarred sauces and biscuits and cakes can all contain hidden salt.  Some people think food with less salt will taste bland. However, it is good to know that within three to four weeks the taste buds will adjust and become more sensitive, so you will get the same amount of flavour from less salt and will even prefer the taste of food with less salt. You will also be able to taste the natural flavours of food. Apart from this, one can use other flavours such as herbs to flavour food.

Five ways to reduce salt

1. Choose whole, unprocessed foods and eat plenty of vegetables and fruit.

2. Check food labels before you buy to help you choose less salty options.

3. Take salt and salty sauces off the table so younger family members won’t develop the habit of adding salt.

4. Use herbs, spices, garlic and citrus instead of salt to add flavour to your food during cooking and at the table.

5. Cut back on processed meats, smoked foods and salty takeaways.

Salt reduction is the simplest, most cost-effective measure for reducing cardiovascular disease because of its high impact on health, high feasibility and low cost of implementation.

Foods high in salt

Anchovies
Bacon
Cheese
Chips (if salt added)
Coated chicken e.g. nuggets
Corn snacks e.g. Wotsits
Gravy granules
Ham
Noodle snacks pots
Olives
Pickles
Potato snacks e.g. Hula Hoops
Prawns
Salami
Salted and dry roasted nuts
Salt fish
Sausages
Smoked meat and fish
Soy sauce
Stock cubes and bouillon
Yeast extract e.g. Marmite
Baked beans
Biscuits
Burgers
Breakfast cereals
Bread and bread products
Cakes and pastries
Cooking sauces
Crisps
Filled pasta
Pasta sauces
Pizza
Potato croquettes    
Ready meals
Soup
Sandwiches
Sausages
Tinned pasta
Tomato ketchup

Foods low in salt

Breakfast cereals*
e.g. Shredded Wheat
Couscous
Eggs
Emmental
Fresh fish
Fresh meat and poultry
Fromage frais
Fruit and vegetables (dried, fresh, frozen and tinned)**
Homemade bread*
Homemade sauces*
Homemade soup*
Mozzarella
Pasta and Rice
Plain cheese spreads
Plain cottage cheese
Plain popcorn
Porridge oats
Pulses (peas, beans, lentils)**
Ricotta
Seeds
Unsalted nuts
Yogurt* with no added salt

* with no added salt
** choose tinned products with no added salt

Charmaine Gauci is Superintendent of Public Health.

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