Trends in Salt Intake and Restriction*

Public health efforts at salt reduction is underway in many countries worldwide. In industrialized countries, estimates are that up to 75% of the salt in the diet comes from that added to food during the manufacturing process. A small amount occurs naturally in some foods, but only 15 to 20% is due to consumer’s choice by adding salt to food at the table or when cooking. 

Suboptimal diet quality is estimated to have led to 678,000 annual deaths from all causes in the U.S. in 2010. In addition to excess intakes of salt, major contributors noted include insufficient intakes of fruits, nuts, seeds, whole grains, vegetables, and seafood. In the United States, an estimated 58,000 annual cardiovascular deaths were associated with sodium intakes of greater than two grams per day in 2010. These deaths represented 1 in 16 of all cardiovascular deaths and 1 in 8 cardiovascular deaths in individuals under the age of 70 years. Globally, an estimated 1.65 million annual cardiovascular deaths  were associated with excess sodium intake representing nearly 1 in 10 of all cardiovascular deaths.

Based on 2009 to 2012 data, 32.6% of US adults over the age of 20 have hypertension affecting about 80 million American adults. African American adults have among the highest prevalence of hypertension in the world with about 45 percent of the population affected. Each year, about 795 000 people experience a new or repeated stroke as the result of high blood pressure. Approximately 610,000 of these are first attacks, and 185,000 are repeat attacks. In 2008, stroke accounted for 1 of every 18 deaths in the United States. On average, every 40 seconds, someone in the United States has a stroke.

The Institute of Medicine of the National Academy of Sciences in the U.S. has recommended reducing salt intake to 2.3 grams per day in the general population. Some scientists have held that these restrictions are not practical. They argue that the worldwide average salt intake is greater and that individuals asked to restrict sodium intake for medical reasons have difficulty doing so.

Both scientific evidence and public health initiatives have led to renewed recommendations from the World Health Organization (WHO) in 2007 and 2012 not to exceed a population average salt intake of 5 grams per day. The WHO also set a target for population salt reduction as a priority to reduce premature cardiovascular mortality by 2025. Revised WHO guidelines now recommend a 30% reduction of salt intake by 2025 and a final maximum target of 5 g per day. The latter target was then adopted by the 66 World Health Assembly through its resolution in 2013.

In order to achieve a population-wide reductions in salt intake, a reformulation of the salt content of food is necessary in addition to encouraging the intake of more fresh fruits and vegetables which are naturally low in sodium.

*The American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The latest update available was reported in 2015 and reported on prior available data.

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation. 2015 Jan 27;131: e29-322.