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Strengthening Knowledge to Practice on Effective Salt Reduction Interventions in Low- and Middle-Income Countries

  • Public Health Nutrition (KE Charlton, Section Editor)
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Abstract

Purpose of Review

The objective of this review was to consolidate available published information on the implementation and evaluation of salt reduction interventions in low- and middle-income countries (LMICs).

Recent Findings

The Science of Salt database (made up of studies identified in a weekly Medline search) was used to retrieve articles related to the implementation of salt reduction interventions from June 2013 to February 2020. Studies that measured the effects of the interventions in LMICs, based on four outcome measures—salt intake; sodium levels in foods; knowledge, attitudes, and behaviours (KABs) towards salt; and blood pressure—were included. Results were summarised overall and according to subgroups of intervention type, duration, sample size, country’s income class, and regional classification. The review identified 32 studies, representing 13 upper middle-income and four lower middle-income countries. The main salt reduction interventions were education, food reformulation, and salt substitution; and many interventions were multi-faceted. More studies reported a positive effect of the interventions (decreased salt intake (12/17); lower sodium levels in foods or compliance with agreed targets (6/6); improved KAB (17/19); and decreased blood pressure (10/14)) than a null effect, and no study reported a negative effect of the intervention. However, many studies were of small scale and targeted specific groups, and none was from low-income countries.

Summary

Consumer education, food reformulation, and salt substitution, either alone or in combination, were effective in their target populations. Supporting scale-up of salt reduction interventions in LMICs is essential to cover broader populations and to increase their public health impact.

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Data Availability

The data used for this study are available from the authors upon reasonable request.

Code Availability

Not applicable

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Funding

This manuscript is based on a previous work funded through a partnership between the World Health Organization and Vital Strategies (Resolve to Save Lives). J Santos is supported by a National Health and Medical Research Council (NHMRC) Postgraduate scholarship (1168948). B McKenzie is supported by a University of New South Wales (UNSW) Scientia Postgraduate Scholarship. E Rosewarne is supported by UNSW Postgraduate Award (00889665) and George Institute Top-Up Scholarship. K Trieu is supported by an NHMRC Early Career Fellowship (1161597) and a Postdoctoral Fellowship (102140) from the National Heart Foundation of Australia. JW is supported by a National Heart Foundation Future Leaders Fellowship II on strengthening and monitoring food policy interventions (1082924). She receives additional funding for work on salt reduction from NHMRC, the Victorian Health Promotion Foundation, Vital Strategies, and the World Health Organization. K Trieu and J Webster are supported by an NHMRC Centre of Research Excellence on food policy interventions to reduce salt (1117300).

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Authors and Affiliations

  1. The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia

    Joseph Alvin Santos, Briar McKenzie, Emalie Rosewarne, Martyna Hogendorf, Kathy Trieu, Mark Woodward, Rebecca Dodd & Jacqui Webster

  2. Independent Nutrition Consultant, Geneva, Switzerland

    Martyna Hogendorf

  3. The George Institute for Global Health, School of Public Health, Imperial College, London, UK

    Mark Woodward

  4. Resolve to Save Lives, an Initiative of Vital Strategies, New York, USA

    Laura K. Cobb

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  1. Joseph Alvin Santos
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Contributions

J Webster and LK Cobb conceived the study. J Santos conducted the search and analysed the data. B McKenzie, E Rosewarne, M Hogendorf, K Trieu, M Woodward, and R Dodd provided input on the preliminary draft of the manuscript. All authors reviewed subsequent versions of the manuscript and approved the final paper.

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Correspondence to Joseph Alvin Santos.

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Joseph Alvin Santos declares that he has no conflict of interest. Briar McKenzie declares that she has no conflict of interest. Emalie Rosewarne declares that she has no conflict of interest. Martyna Hogendorf declares that she has no conflict of interest. Kathy Trieu declares that she has no conflict of interest. Mark Woodward has received compensation from Amgen, Freeline, and Kyowa Kirin for service as a consultant. Laura K. Cobb declares that she has no conflict of interest. Rebecca Dodd declares that she has no conflict of interest. Jacqui Webster is the Director of the World Health Organization Collaborating Centre on Population Salt Reduction with a remit to support countries to implement and evaluate salt reduction programs in line with the WHO target for all countries to reduce population salt intake by 30% by 2025.

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Santos, J.A., McKenzie, B., Rosewarne, E. et al. Strengthening Knowledge to Practice on Effective Salt Reduction Interventions in Low- and Middle-Income Countries. Curr Nutr Rep 10, 211–225 (2021). https://doi.org/10.1007/s13668-021-00365-1

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