TODAY is World Heart Day (WHD). Worried by the rising cases of hypertension, heart diseases, stroke, kidney failure and resultant sudden deaths, the World Health Organisation (WHO) has called on countries to take action on the overuse of salt by implementing it’s sodium reduction recommendations to cut the number of people experiencing the disease conditions and, in turn, save lives.According to a study in the Journal of the American Society of Nephrology (JASN), reducing salt intake provides clear benefits for the heart and kidney health of patients with chronic kidney disease. The findings point to the power of salt restriction in potentially prolonging kidney disease patients’ lives.
The World Heart Day is a day set aside by the World Heart Federation (WHF) with the support of the World Health Organisation (WHO) to emphasise the importance of the heart, promote awareness on heart disease, the risk factors, and the preventive measures to reduce the known risk factors.
If nothing was done urgently to address the situation, more Nigerians will succumb heart-related diseases such as hypertension, stroke, heart attack, kidney failure, among others.
Until now, non-communicable diseases (NCDs), including heart disease and stroke, are the leading causes of premature death in the 21st century.
Several but recent studies have shown that increasing production of more and more processed food, rapid urbanization, and changing lifestyles are transforming dietary patterns. Highly processed foods are increasing in availability and becoming more affordable.
Indeed, the World Health Organisation (WHO), in a statement, yesterday, ahead of the WHD, said people around the world are consuming more energy-dense foods that are high in saturated fats, trans fats, sugars, and salt. Salt is the primary source of sodium and increased consumption of sodium is associated with hypertension and increased risk of heart disease and stroke.
The Nigerian Heart Foundation (NHF), Nutrition Society of Nigeria (NSN) and the Nigerian Society for Endocrinology and Metabolism (NSEM) had alerted that people are consuming less fruit vegetables and dietary fibre (such as whole grains), that are key components of a healthy diet. Fruits and vegetables contain potassium, which contributes to reduce blood pressure.
They said salt in the diet could come from processed foods, either because they are particularly high in salt (such as ready meals, processed meats like bacon, ham and salami, cheese, salty snack foods, and instant noodles, among others) or because they are consumed frequently in large amounts (such as bread and processed cereal products). Salt is also added to food during cooking (bouillon and stock cubes) or at the table (soy sauce, fish sauce and table salt).
The National Agency for Food and Drug Administration and Control (NAFDAC) and the NHF recently disclosed that some manufacturers are reformulating recipes to reduce the salt content of their products and consumers and advised Nigerians to read food labels and choose products low in sodium.
The NHF listed the causes of heart-related diseases to include inactivity (which results in obesity) high salt-intake and fast foods.
Executive Director of NHF, Dr. Kola Akinroye, told The Guardian yesterday: “Consuming too much salt can lead (or contribute) to hypertension, or high blood pressure, and greatly increase the risk of heart disease and stroke.
Akinroye said: “On average, people consume around 10 grams of salt per day. This is around double WHO’s recommended level from all sources, including processed foods, ready-made meals and food prepared at home (less than 5 grams or under one teaspoon per day). WHO recommends that children aged two to 15 years consume even less salt than this, adjusted to their energy requirements for growth.”
Akinroye said the salt content of food does a lot of damage to the body. “The higher the salt content, the more you are prone to developing ... stroke in the brain, stroke in the heart, which is heart attack and stroke in the kidney which is kidney failure. Then you talk about cholesterol and the amount of fat in the food. The higher the cholesterol, the higher the chances of stroke, heart attack and kidney damage. Hypertension, that is, high blood pressure. Smoking is also a problem. The blood vessels get thickened,” Akinroye said.
He added: “Heart disease and stroke were largely preventable if the main risk factors, including high blood pressure, high levels of cholesterol and blood glucose, inadequate intake of fruit and vegetables and obesity and physical inactivity are reduced.
“We have data that the number one heart disease in Nigeria is hypertension... if we are using the latest figure of the WHO which says that any blood pressure above 140/90 mm/g is hypertension. The data we have now says that more than 25 per cent of the adult population in Nigeria or not less than are hypertensive.”
Hypertension, according to Akinroye, simply means the narrowing of the blood vessels, meaning blood is no longer flowing as it should flow. “It can get to a stage whereby the blood supply to a particular organ could either be blocked or the vessel itself can burst open leading to stroke when it happens in the brain, heart failure or attack when it happen in the heart and kidney failure when it happens in the kidney,” he said.
The WHO said it is supporting governments to implement the “Global action plan to reduce noncommunicable diseases” that comprises nine global targets, including one to reduce global salt intake by a relative 30 per cent by 2025.
WHO Assistant Director-General for Noncommunicable Diseases and Mental Health, Dr Oleg Chestnov, said: “If the target to reduce salt by 30 per cent globally by 2025 is achieved, millions of lives can be saved from heart disease, stroke and related conditions.”
According to the WHO, the main source of sodium in our diet is salt. It can come from sodium glutamate and sodium chloride, and is used as a condiment in many parts of the world. In many countries, 80 per cent of salt intake comes from processed foods such as bread, cheese, bottled sauces, cured meats and ready-made meals.
Chestnov said: “Salt is in almost everything we eat, either because high levels of salt are found in most processed and prepared foods, or because we are adding salt when we prepare food at home.”
Chestnov said that reducing salt intake is one of the most effective ways for countries to improve population health, and urged the food industry to work closely with WHO and national governments to incrementally reduce the level of salt in food products.
A WHO Fact Sheet on salt intake reads: “High sodium consumption (>2 grams/day, equivalent to 5 g salt/day) and insufficient potassium intake (less than 3.5 grams/day) contribute to high blood pressure and increase the risk of heart disease and stroke.
“The main source of sodium in our diet is salt, although it can come from sodium glutamate, used as a condiment in many parts of the world.
“Most people consume too much salt—on average 9–12 grams per day, or around twice the recommended maximum level of intake.
“Salt intake of less than 5 grams per day for adults helps to reduce blood pressure and risk of cardiovascular disease, stroke and coronary heart attack. The principal benefit of lowering salt intake is a corresponding reduction in high blood pressure.
“WHO Member States have agreed to reduce the global population’s intake of salt by a relative 30 per cent by 2025.
“Reducing salt intake has been identified as one of the most cost-effective measures countries can take to improve population health outcomes. Key salt reduction measures will generate an extra year of healthy life for a cost that falls below the average annual income or gross domestic product per person.
“An estimated 2.5 million deaths could be prevented each year if global salt consumption were reduced to the recommended level.”
How to reduce salt in diets
According to the Journal of the American Society of Nephrology (JASN) study, excessive salt intake is consistently linked to increased risk of heart disease and worsening kidney function. People with chronic kidney disease (CKD) may be particularly susceptible to salt’s detrimental effects due to the kidney’s important role in controlling salt balance and their increased risk of dying from heart disease. Until now, though, the effect of salt restriction in these patients has not been well explored.
The researchers found that on average, low salt intake reduced excess extracellular fluid volume by one liter, lowered blood pressure by 10 /4 mm Hg, and halved protein excretion in the urine, without causing significant side effects.
The findings suggest that salt restriction is an inexpensive, low-risk and effective intervention for reducing cardiovascular risk and risk of worsening kidney function in people with CKD.
The WHO said government policies and strategies should create environments that enable populations to consume adequate quantities of safe and nutritious foods that make up a healthy diet including low salt. Improving dietary habits is a societal as well as an individual responsibility. It demands a population-based, multisectoral, and culturally relevant approach.
According to the WHO, key broad strategies for salt reduction include: government policies - including appropriate fiscal policies and regulation to ensure food manufacturers and retailers produce healthier foods or make healthy products available and affordable; working with the private sector to improve the availability and accessibility of low-salt products; consumer awareness and empowerment of populations through social marketing and mobilization to raise awareness of the need to reduce salt intake consumption.
Others include: creating an enabling environment for salt reduction through local policy inter-ventions and the promotion of “healthy food” settings such as schools, workplaces, communities, and cities; monitoring of population salt intake, sources of salt in the diet and consumer knowledge, attitudes and behaviours relating to salt to inform policy decisions; salt reduction programmes and programmes that promote fortification with micronutrients of salt, condiments or seasonings high in salt (bouillon cubes, soy and fish sauce) can complement each other.
Salt consumption at home can be reduced by: not adding salt during the preparation of food; not having a salt shaker on the table; limiting the consumption of salty snacks; and choosing products with lower sodium content.
Other local practical actions to reduce salt intake include: integrating salt reduction into the training curriculum of food handlers; removing salt shakers and soy sauce from tables in restaurants; Introducing product or shelf labels making it clear that certain products are high in sodium; providing targeted dietary advice to people visiting health facilities; advocating for people to limit their intake of products high in salt and advocating that they reduce the amount of salt used for cooking; and educating children and providing a supportive environment for children so that they start early with adopting low salt diets.
Actions by the food industry should include: incrementally reducing salt in products over time so that consumers adapt to the taste and don’t switch to alternative products; promoting the benefits of eating reduced salt foods through consumer awareness activities in food outlets; reducing salt in foods and meals served at restaurants and catering outlets and labelling sodium content of foods and meals.
The “Global Strategy on Diet, Physical Activity and Health” was adopted in 2004 by the World Health Assembly (WHA). It calls on governments, WHO, international partners, the private sector and civil society to take action at global, regional and local levels to support healthy diets and physical activity.
In 2010, the WHA endorsed a set of recommendations on the marketing of foods and non-alcoholic beverages to children. These guide countries in designing new policies and strengthening existing ones to reduce the impact on children of the marketing of unhealthy food. WHO is also helping develop a nutrient profile model that countries can use as a tool to implement the marketing recommendations.
In 2011, world leaders committed to reducing people’s exposure to unhealthy diets. The commitment was made through a Political Declaration of the High-level Meeting of the United Nations General Assembly on the Prevention and Control of NCDs.
In 2013, the WHA agreed nine global voluntary targets for the prevention and control of NCDs, which include a halt to the rise in diabetes and obesity and a 30% relative reduction in the intake of salt by 2025. The “Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020” gives guidance and a menu of policy options for Member States, WHO and other UN agencies to achieve the targets.
Also in 2012, the WHA adopted six global nutrition targets, including the reduction of stunting, wasting and overweight in children, the improvement of breastfeeding and the reduction of anaemia and low birth weight.
With many countries now seeing a rapid rise in obesity among infants and children, WHO in May 2014 set up a commission on childhood obesity. The Commission will draw up a report for 2015 specifying which approaches and actions are likely to be most effective in different contexts around the world.
These recommendations apply to all individuals, with or without high blood pressure (including pregnant and lactating women), except individuals with illnesses or those taking drug therapy that may lead to low sodium levels or acute build-up of body water, or require physician-supervised diets (example patients with heart failure and those with type I diabetes). In these subpopulations, there may be a particular relationship between sodium intake and the health outcomes sought.
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