Abstract:
Introduction. Excess salt consumption is a main determinant of the disease burden ascribed to high blood pressure leading to many serious complications, premature mortality
and significant health costs. Based on clear evidence on the link between salt intake, blood
pressure and vascular risk, the WHO recommends to implement salt reduction strategies.
A 30% lowering in the mean population salt intake by 2025 has been included as one of
the targets of the ‘25 by 25’ WHO initiative for the control and prevention of noncommunicable diseases.
Material and methods. Electronic database PubMed was searched for studies reporting
on salt intake and salt reduction strategies in India published between 2011 and 2021. Data
were retrieved also form the websites of India’s official health authorities and WHO. Search
was done using keywords and was limited to studies published in English language.
Results. Cardiovascular diseases (CVDs) became the leading cause of disease burden and
death in India during the last decades. Overall, CVDs contributed 28.1% of the total death
and 14.1% of the total disability-adjusted life-years (DALYs) in India in 2016 compared
with 15.2% and 6.9%, respectively, in 1990. Dietary risks (56.4%), including high sodium
intake, and related high systolic blood pressure (54.6%) are the two leading and overlapping risk factors contributing to DALYs in 2016. Salt intake is very high across different
regions of India with the average daily intake ranging between 9 and 12 grams daily.
The intake is reported to be higher in urban settings compared to rural settings. A recent
large study from south India revealed that mean dietary sodium intake was significantly
higher in the hypertensive men (4.2±2 g/day) and women (3.2±1.7 g/day) compared with
normotensive men (4±2 g/day), and women (3.2±1.7 g/day; P<0.05).
Discretionary salt is the main contributor of excess dietary salt. Knowledge, attitudes, and
practices of the population regarding optimal salt intake are generally poor. India aims at
a 20% and 30% reduction in salt intake by 2020 and 2025 respectively. Population-based
strategies on reducing salt consumption need to be effectively implemented given the high
prevalence and growing burden of hypertension. India plans to use WHO’s Three Pillars of
product reformulation, consumer awareness and education campaigns and environmental
changes to reduce salt intake in the population.
The proposed advertisement bans on foods high in fat, sugar, and salt by the Food Safety
and Standards Authority of India in 2017 is a step towards reducing some of these risks
that contribute to the burden of CVDs. India is part of the regional main strategy on public
education and behavior change communication regarding salt reduction adopted in 2014
by countries of South-East Asia region. Counseling regarding salt reduction is provided in
the primary care settings.
Conclusions. (1) The burden of cardiovascular diseases is increasing in India, with high
salt intake as one of the main risk factors. (2) An effective awareness raising, and public
education initiative need to be implemented, involving macrolevel factors.
