Skip to main content
PMC home page
The Journal of Clinical Hypertension logoLink to The Journal of Clinical Hypertension
. 2014 Sep 29;17(1):7–9. doi: 10.1111/jch.12402

2014 Dietary Salt Fact Sheet of the World Hypertension League, International Society of Hypertension, Pan American Health Organization Technical Advisory Group on Cardiovascular Disease Prevention Through Dietary Salt Reduction, the World Health Organization Collaborating Centre on Population Salt Reduction, and World Action on Salt & Health

Norm RC Campbell 1,✉, Daniel T Lackland 2, Mark L Niebylski 3
PMCID: PMC8031790  PMID: 25265529

Diets High in Salt (Sodium) are Associated With a High Burden of Premature Death and Disability

  • High dietary salt increases blood pressure (BP) in individuals with and without hypertension. One half of blood pressure–related disease occurs in people with higher levels of BP even within the normal range.

  • High dietary salt causes an estimated 30% of hypertension or over 300 million people to have hypertension.1, 2

  • Increased BP is a leading preventable risk factor for heart disease (heart attack and heart failure), stroke, and kidney failure, and is a major contributor to premature death, dementia, disability, and healthcare costs.2

  • In the Global Burden of Disease Study, best evidence estimated more than 3 million deaths, 61 million years of disability (DALYs), and 57 million years of life lost in 2010 as a result of excess dietary salt (http://viz.healthmetricsandevaluation.org/gbd-compare/).

  • Other diseases associated with high salt intake include gastric cancer (probable procarcinogen), recurrent kidney stones (causal association), osteoporosis, obesity, and direct renal, vascular, and cardiac damage.3

Globally, People Consume Too Much Salt

  • The recommended daily intake level of salt for healthy adults is <5 g/d (sodium <2000 mg/d) and with lower levels in children based on their lower caloric needs.4

  • Globally, the average intake of salt per adult is 10 g/d (sodium 4000 mg/d), with higher intakes in Asia.5

  • Salt intake in fully developed economies largely comes from prepackaged, processed, and restaurant foods. In undeveloped economies, the largest source is “discretionary” and added in cooking and at the table. Only a small portion (one tenth) is naturally found in food. In developing economies, nutritional transition is increasing the exposure of populations to salt in processed foods.6, 7

There is a Strong Consensus that Reduction in Dietary Salt Saves Lives, Healthcare Resources, and Dollars

  • Reducing dietary salt is one of the most impactful and cost‐effective mechanisms to improve population health and is considered one of a few “best buys” to prevent chronic disease by the World Health Organization.6, 7

  • The threat to the global economy and development posed by noncommunicable diseases led the United Nations to make nine targets for prevention and control—reducing dietary salt by 30% was one of the key recommendations.8

  • Repeated comprehensive critical appraisals of the literature under the auspices of national governments and high‐profile scientific organizations uniformly conclude that dietary salt needs to be reduced and that high dietary salt causes disease. 4, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 Only the food and salt industry, their consultants, and a few dissenting scientists are in disagreement.

Approaches to Reduce Dietary Salt Need to Be Strengthened Globally

  • Governments in most countries need to take action to develop and implement multisectoral national strategies to reduce salt.

  • Regulatory approaches are most effective while voluntary approaches with strong government oversight have had some success.13, 25

  • Public education is important, especially where discretionary salt is the major dietary source.31

  • Close monitoring of salt intake, sources of salt in the diet, salt levels in foods, and knowledge, attitudes, and behaviors of the public are essential components of salt reduction programs.32

  • Integrating efforts to reduce dietary salt with those to prevent iodine deficiency through salt fortification are important to optimize population health.33, 34

  • Global networks of concerned healthcare professionals and scientists have formed to help support reductions in dietary salt. The World Action on Salt & Health sponsors World Salt Week during the second week of March annually (www.worldactiononsalt.com/). Other organizations include the Australian Division of World Action on Salt & Health (www.awash.org.au), the Consensus Action on Salt & Health (http://www.actiononsalt.org.uk/), and the Latin American Action on Health & Salt Coalition (http://www.alass.net/).

The World Hypertension League Actions

Acknowledgment

This fact sheet was developed by the authors, with assistance and input from the supporting organizations in the title.

J Clin Hypertens (Greenwich). 2015;17:7–9. DOI: 10.1111/jch.12402. © 2014 Wiley Periodicals, Inc.

References

  • 1. Committee on Public Health Priorities to Reduce and Control Hypertension in the U.S. Population, Institute of Medicine of the National Academies . A population‐based policy and systems change approach to prevent and control hypertension. Report v‐173. Washington, DC: National Academies Press; 2010. [PubMed] [Google Scholar]
  • 2. World Health Organization . A global brief on hypertension: silent killer, global public health crisis. World Health Day 2013. Report 1–39. Geneva, Switzerland: WHO Press, World Health Organization; 2013. [Google Scholar]
  • 3. de Wardener HE, MacGregor GA. Harmful effects of dietary salt in addition to hypertension. J Hum Hypertens. 2002;16:213–223. [DOI] [PubMed] [Google Scholar]
  • 4. World Health Organization . WHO guideline: sodium intake for adults and children. Report i‐46. Geneva, Switzerland: WHO Press, World Health Organization; 2012. [PubMed] [Google Scholar]
  • 5. Powles J, Fahimi S, Micha R, et al. Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ Open. 2013;3:e003733. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6. Wang G, Labarthe D. The cost‐effectiveness of interventions designed to reduce sodium intake. J Hypertens. 2011;29:1693–1699. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7. World Economic Forum, World Health Organization . From burden to “best buys”: reducing the economic impact of non‐communicable diseases in low‐ and middle‐income countries . Report 1–11. Geneva, Switzerland: World Economic Forum; 2011. [Google Scholar]
  • 8. United Nations General Assembly . Note by the Secretary‐General transmitting the report of the Director‐General of the World Health Organization on the prevention and control of non‐communicable diseases. Report 1–19. New York, NY: Department for General Assembly and Conference Management; 2013.
  • 9. Scientific Advisory Committee on Nutrition . Salt and health. Scientific Advisory Committee on Nutrition. Norwich, UK: The Stationery Office; 2003: 1–134.
  • 10. Appel LJ, Brands MW, Daniels SR, et al. Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension. 2006;47:296–308. [DOI] [PubMed] [Google Scholar]
  • 11. Dickinson BD, Havas S. Reducing the population burden of cardiovascular disease by reducing sodium intake: a report of the council on science and public health. Arch Intern Med. 2007;167:1460–1468. [DOI] [PubMed] [Google Scholar]
  • 12. American Public Health Association . Reducing sodium content in the American diet. American Public Health Association—Association News 2002 Policy Statements. Fort Worth, TX: American Public Health Association; 2002:5–6. [Google Scholar]
  • 13. Henny JE, Taylor CL, Boon CS. Strategies to reduce sodium intake in the United States. Washington, DC: The National Academies Press; 2010. [PubMed] [Google Scholar]
  • 14. Strom BL, Anderson CA, Ix JH. Sodium reduction in populations: insights from the institute of medicine committee. JAMA. 2013;310:31–32. [DOI] [PubMed] [Google Scholar]
  • 15. Institute of Medicine of the National Academies . Sodium intake in populations: assessment of evidence. In: Strom BL, Yaktine AL, Oria M, eds. Institute of Medicine of the National Academies. Report V‐F‐44. Washington, DC: The Academies Press; 2013. [PubMed] [Google Scholar]
  • 16. Appel LJ, Frohlich ED, Hall JE, et al. The importance of population‐wide sodium reduction as a means to prevent cardiovascular disease and stroke: a call to action from the American Heart Association. Circulation. 2011;123:1138–1143. [DOI] [PubMed] [Google Scholar]
  • 17. Panel on Dietary Reference Intakes for Electrolytes and Water, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. Scientific Evaluation of Dietary Reference Intakes. Washington DC: The National Academies Press; 2004:1–640.
  • 18. World Health Organization . Report of the Formal Meeting of Member States to conclude the work on the comprehensive global monitoring framework, including indicators, and a set of voluntary global targets for the prevention and control of noncommunicable diseases. Report 1–6. Geneva, Switzerland: WHO Press, World Health Organization; 2012. [Google Scholar]
  • 19. World Health Organization Nutrition and Food Security Programme . Food‐based dietary guidelines in the WHO European region. Copenhagen, Denmark: World Health Organization; 2003:1–38. [Google Scholar]
  • 20. Provincial and Territorial Ministers of Health and Healthy Living. Reducing the sodium intake of Canadians: a provincial and territorial report on progress and recommendations for future action. Report i‐422012. Canada's Provincial and Territorial Ministers of Health and Healthy Living. 2012.
  • 21. Sodium Working Group . Sodium reduction strategy for Canada—recommendations of the Sodium Working Group. Report 1–61. Ottawa, Canada: Health Canada; 2010. [Google Scholar]
  • 22. Whelton PK, Appel LJ, Sacco RL, et al. Sodium, blood pressure, and cardiovascular disease: further evidence supporting the American Heart Association sodium reduction recommendations. Circulation. 2012;126:2880–2889. [DOI] [PubMed] [Google Scholar]
  • 23. Campbell NR, Legowski B, Legetic B. Mobilizing the Americas for dietary salt reduction. Lancet. 2011;377:793–795. [DOI] [PubMed] [Google Scholar]
  • 24. Legetic B, Campbell N. Reducing salt intake in the Americas: Pan American Health Organization actions. J Health Commun. 2011;16(suppl 2):37–48. [DOI] [PubMed] [Google Scholar]
  • 25. Cappuccio FP, Capewell S, Lincoln P, McPherson K. Policy options to reduce population salt intake. BMJ. 2011;343:d4995. [DOI] [PubMed] [Google Scholar]
  • 26. Webster JL, Dunford EK, Hawkes C, Neal BC. Salt reduction initiatives around the world. J Hypertens. 2011;29:1043–1050. [DOI] [PubMed] [Google Scholar]
  • 27. Webster J, Dunford E, Huxley R, et al. The development of a national salt reduction strategy for Australia. Asia Pac J Clin Nutr. 2009;18:303–309. [PubMed] [Google Scholar]
  • 28. Chalmers J, Arima H, Harrap S, et al. Global survey of current practice in management of hypertension as reported by societies affiliated with the International Society of Hypertension. J Hypertens. 2013;31:1043–1048. [DOI] [PubMed] [Google Scholar]
  • 29. Campbell N, Lackland D, Chockalingam A, et al. The World Hypertension League and International Society of Hypertension call on governments, nongovernmental organizations, and the food industry to work to reduce dietary sodium. J Clin Hypertens (Greenwich). 2014;16:99–100. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30. Lim SS, Vos T, Flaxman AD, 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. Lancet. 2012;380:2224–2260. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31. World Health Organization . Creating an enabling environment for population‐based salt reduction strategies. Report of a joint technical meeting held by WHO and the Food Standards Agency, United Kingdom, July 2010. 2011;1:3–42.
  • 32. World Health Organization . Strategies to monitor and evaluate population sodium consumption and sources of sodium in the diet: report of a joint technical meeting convened by WHO and the Government of Canada. Canada October 2010. Report 3–40. Geneva, Switzerland: WHO Press, World Health Organization; 2011. [Google Scholar]
  • 33. World Health Organization . Salt reduction and iodine fortification strategies in public health. Report 1–34. Geneva, Switzerland: WHO Press, World Health Organization; 2013.
  • 34. Pan American Health Organization . Salt‐smart Americas: a guide for country‐level action. Report ix‐159. Washington, DC: Pan American Health Organization; 2013

Articles from The Journal of Clinical Hypertension are provided here courtesy of Wiley

RESOURCES