Cutting just 1g of salt a day could prevent millions of cases of heart disease

About four million lives could be saved by 2030 if 1g of salt were cut from the daily diet of Chinese citizens within a year and maintained. A modest cut of just 1g in daily salt intake could prevent nearly nine million cases of heart disease and stroke and save four million lives by 2030, suggests a modeling study published in the open-access journal BMJ Nutrition Prevention & Health.

Salt intake in China is among the highest in the world, averaging 11g/day – more than double the amount recommended by the Chinese government. High salt intake increases blood pressure, and therefore, the risk of cardiovascular (heart) disease, which accounts for 40% of all deaths in China each year. The researchers set out to estimate the health gains that could be achieved by reducing salt intake nationwide, with the aim of helping to inform the development of feasible salt reduction programs.

They compiled the most recent and most reliable figures for population size, salt intake, blood pressure and disease rates by region and age, then estimated the impact on cardiovascular health for three different approaches. The first is a 1g/day reduction in salt intake to be achieved within one year. The second is the World Health Organization (WHO) interim target of a 30% reduction by 2025 – equivalent to a gradual reduction of 3.2g/day.

The third is to reduce salt intake to less than 5g/day by 2030, a target set by the Chinese government in its action plan for health and development called Healthy China 2030. They then estimated the drop in systolic blood pressure – the higher number in the blood pressure reading that indicates the force with which the heart pumps blood around the body – and the risk of heart attack/stroke and death from cardiovascular disease.

Given that, on average, adults in China consume 11g/day of salt, reducing this by 1g/day should lower average systolic blood pressure by about 1.2mmHg. And if this reduction is achieved within a year and continues, approximately nine million cases of heart disease and stroke could be prevented by 2030 – four million of which are fatal. Keeping this up for another 10 years could add up to around 13 million heart attacks and strokes avoided – six million of them fatal.

Achieving the WHO interim target by 2025 requires a 3.2g/day reduction in salt intake. If this is maintained for another five years, a cumulative total of about 14 million cases of heart disease and stroke could be prevented by 2030 – six million of which are fatal. And if maintained until 2040, the cumulative number could reach around 27 million cases – 12 million of which would be fatal.

Achieving the Healthy China 2030 target requires a 6g/day reduction in salt intake, reducing average systolic blood pressure by more than 7mmHg, adding up to 17 million cases of heart disease and stroke prevented – eight million of which are fatal. The benefits of a reduction in dietary salt intake would apply to men and women of all ages across China, the researchers said.

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There may also be additional health benefits, which the lack of relevant data does not allow researchers to estimate. These include the secondary prevention of cardiovascular disease and the reduction of cases of chronic kidney disease and stomach cancer, the rates of which are already high or rising in China, they suggest. The Chinese government’s action plan, Healthy China 2030, includes dietary recommendations to reduce salt, sugar and oil intake.

This modeling study shows that salt reduction alone can bring substantial health benefits to the entire Chinese population,” the researchers said, adding that a 1g daily reduction in intake “would be easily achievable”. But they highlight: “Our estimates rely on salt reduction to not only be achieved, but also sustained over time, which may be a great challenge given the rapidly changing dietary patterns seen in China, given its rapid urbanization.”

They concluded: “The evidence for large benefits of salt reduction in China is consistent and compelling. Achieving and maintaining population salt reduction in China could prevent millions of cardiovascular events and unnecessary deaths. Given China’s large population, this will also bring great benefits to global health. Modeling studies like this provide an indication of how specific dietary changes have the potential to alter the course of diet-related disease.

Commented Shane McAuliffe, Head of Science and Digital Communications at NNEdPro’s Center for Nutrition and Global Health, which co-owns. the journal. Given the well-established dose-response relationship between salt intake, systolic blood pressure and cardiovascular disease, reducing the intake of one of the highest global consumers would have a significant impact on population health – something that has been achieved in other countries around the world,” he added.

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