Salt and health: Take it with a pinch of salt

By Claire Johnson

Published on Feb 9, 2017

Cardiovascular diseases are the leading cause of death in India responsible for about 2.3 million deaths each year, which is approximately 23% of all mortality 1.  Of these deaths, 24% are attributed to high blood pressure 2. High blood pressure is the leading risk for non-communicable disease, in India where the prevalence rates of hypertension are anticipated to nearly double from 118 million in 2000 to 213 million by 2025 3.  Salt is a leading cause of high blood pressure and has been associated with the risk of vascular disease as well as other serious health problems 4,5.

The 2010 Global Burden of Disease study reported excess salt intake to be the 7th leading cause of global mortality responsible for 1.65 million deaths from cardiovascular disease 1,3. All Member States of the World Health Organization, including India, have adopted a 30% reduction in mean population salt consumption by 2025 as part of the ‘25 by 25’ initiative for the control of non-communicable diseases 6.

In support of the development of a national salt reduction strategy for India the George Institute for Global Health, India has completed a large population survey of dietary salt intake using the 24hr urine assessment method in urban and rural areas in Delhi/Haryana and Andhra Pradesh. Additionally, it assessed participant’s knowledge, attitude and behavioural (KAB) practices towards salt consumption and a stakeholder analysis was undertaken involving government, industry, consumers and civil society organizations as well as a systematic quantitative evaluation of packaged foods available for purchase in Delhi and Hyderabad supermarkets.

There were 1,041 persons selected for the survey in Delhi/Haryana and 712 (68%) agreed to participate. The corresponding number for Andhra Pradesh were 1,291 and 840 (65%). Overall urinary salt excretion was estimated to be 8.59 g/day in Delhi/Haryana and 9.46 g/day in Andhra Pradesh. Intake was highest in urban slum sites, next highest in rural sites and lowest in slum sites in Delhi/Haryana and the pattern appeared similar in Andhra Pradesh though was not significantly different across area of residence in that state.

In the KAB survey, the majority of participants reported that the maximum salt consumption recommendation as <5 g/day (70%) and 90% were aware that a diet high in salt can cause serious health problems. About half (52%) of participants reported that lowering salt in their diets was important but 78% of participants reported “always” adding salt to cooking.

Of 7,428 packaged food product data collected between 2012 and 2014, a total of 5,686 individual products were included in the analysis. Total number of products meeting national Food Safety and Standards Authority of India guidelines for nutrition labelling were 2425 (43%), total number of products labelled for sodium were 2027 (34%).

These data make a strong case for action on salt consumption in India. While the formation of a salt reduction strategy that will be best suited to India will require the synthesis of this data with multiple other data sources it is likely that a combination of actions targeting consumers, industry and government will be required.  The available evidence from other jurisdictions and extensive modelling suggest that a salt reduction program in India would both prevent large numbers of incident cases of hypertension as well as strokes and heart attacks.  Further, it is likely that this would be achieved at low total cost and in a highly cost-effective way.

Claire Johnson is Research Associate (Food Policy Division) at The George Institute for Global Health, Australia.  This work was supported by a funding award made by the Global Alliance for Chronic Disease through the National Health and Medical Research Council of Australia.



1. Lim, S.S., et al., A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet, 2013. 380(9859): p. 2224-2260

2. Gupta, R., Trends in Hypertension Epidemiology in India. Journal of Human Hypertension, 2004. 18(2): p. 73-78

3. Mozaffarian, D., et al., Global sodium consumption and death from cardiovascular causes. New England Journal of Medicine, 2014. 371(7): p. 624-634.

4. World Health Organization, Reducing salt intake in populations: report of a WHO forum and technical meeting, 5-7 October 2006, Paris, France. 2007.

5. Asaria, P., et al., Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use. The Lancet, 2007. 370(9604): p. 2044-2053.

6. World Health Organisation, Draft comprehensive global monitoring framework and targets for the prevention and control of non-communicable diseases. 2013.


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