Reducing Salt Consumption Among the Population

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Table of Contents

Introduction
Policy Background
Analysis of policy approach
Analysis of policy setting
Recommendations for policy
References:

Introduction

The role of diet in modulating the health is an important factor in the society. With the available diet formulations in hand, a plethora of changes have been under consideration to improve the delicacy and nutrient quality of food. The taste inducing components like salt and sugar have central role to influence the diet habits and hygiene. They may be consumed in a moderate degree to a high amount. But it is unknown whether the beneficial or the harmful effects of high consumption could lead to health problems directly or indirectly. It is well known that the intake of any dietary compound above the recommended dose would be harmful.

But this may need a scientific evidence for reliable, trustworthy information. Therefore, the present description is concerned with highlighting about the importance of low or reduced salt consumption among population keeping in view of its adverse health affects. Salt is known to be available as sodium chloride or table salt has tremendous influence in terms of its ecoeconomic and physiological influence in the society (Lozada et al., 2007).

This is because of its appetite inducing properties (Lozada et al., 2007).However, salt has been a priority component for health of individuals as its high intake was likely to contribute to problems like the development of hypertension (Lozada et al., 2007). It was also known to be the leading causative factor for the morbidity in both developed and developing countries. As such, there is a further need to explore the literature keeping in view of fortification of food by mandatory and voluntary strategies, promotion of supplements and general education.

Policy Background

Firstly, there is a need to focus on food fortification because there is a connection between excessive iodination of salt (40 to 100 mg/kg) and increased prevalence of chronic autoimmune thyroiditis and iodine-induced hyperthyroidism, according to a Brazilian study (Medeiros-Neto, 2009).

Similarly, there has been much emphasis on this issue as earlier policy makers attempted to signify the importance of food fortification due to the risk of iodine induced hyperthyroidism (IIH) (www.daa.asn.au). They believe that mandatory fortification of food could regulate the iodine content if allowed to increase gradually in different stages. The ultimate objective is to guarantee a safer increase in iodine levels of food in a more reliable manner. Dietary paradigms are in progress to study the influence of mandatory programs and voluntary iodine fortification strategies.

A study has been conducted to better understand the iodine content in foods after the introduction of mandatory iodine fortification program (Rasmussen et al., 2007). Here, rye breads, wheat breads and salt samples were considered for the study to determine the increase in iodine intake due to the fortification. It was revealed that iodization was successful in nearly 98% of the rye breads and 90% of the wheat breads were iodized. The iodine intake in breads was only 13-43 microg/day (Rasmussen et al., 2007). This study may help us to analyse the amount of iodine present in a given supplement like bread. However, this study may seem to reflect the increase in intake of iodine in the fortification program.

According to the Heart Foundation’s Tick Program, salt reduction in the food supply would be possible by setting the sodium limits for the approval in various food categories including bread and margarines (www.daa.asn.au). It was anticipated that the restrictions would encourage manufacturers to lessen the sodium levels in food supplements (www.daa.asn.au). Surveillance studies from French Food safety agency (AFSSA) on salt content revealed that food groups like breakfast cereals, some soups na and some cheeses had lower salt content when compared to bread , ready to eat meals that have high salt content ( WHO bulletin ).

This could indicate that the food fortification programs need to be strictly monitored keeping in view of the salt content present in variety of food products. A voluntary program may better help the population to understand the risk benefit ration inherent in a fortified food.

It was widely accepted that in order to achieve a reduced salt consumption among people, salt iodization need to be given paramount importance (WHO report, 2007). This is because salt iodization minimizes the risk of iodine deficiency disorder (IDD) (WHO report, 2007). There are two approaches to manage this problem. Iodine supplementation which is achievable by oral administration of slow- release preparation such as iodized salt once a year and iodine fortification of foods, generally salt (WHO report, 2007).

In most countries, there are strategies aimed to reduce salt intake on a population wide basis which is one of the component of nutritional policy and disease prevention policy (WHO report, 2007).These include salt labeling regulation, consumers’ awareness campaigns, developmental symbols to identify low salt products, agreements with the food industry to lower the salt content of a wide range of products, and monitoring sodium content of food (WHO report, 2007).

Next, there is a need to implement educational campaigns to guarantee that the sufficient consumption of iodine would not interfere with the standard health recommendations to minimize the blood pressure by the reduction of dietary salt intake. Here it was believed that countries like Australia, most women are unable to meet their standard iodine requirements during the period of pregnancy or lactation. Hence, a well planned, targeted educational campaign highlighting the significance of the use of vitamin supplements that contain iodine and folate was considered vital in ensuring that iodine requirements are met during pregnancy and lactation. Educational messages also need to be developed for those population groups who hardly consume bread.

Therefore, policies targeting the reduction of dietary salt consumption need to be implemented in the area of food production through the development of products and meals without the addition of salt or with the minimum content of sodium, changes in the environment that guarantees that the healthier food items are the easiest choice for the consumer (e.g. through system of a clear labeling of all processed foods and meals) and through wide and active health promotion and consumer education (in all population groups) (WHO report, 2007).

The promotional strategies should be such that the utility of iodized salt as an ingredient in a given food of choice like bread should not contribute to the hindrances for the promotion of dietary guidelines on reduced salt consumption. The strategies should rather be able to produce reduced salt processed foods with adequate amounts of iodine to help improve the iodine status of whole population. It was reported that mandatory fortification program would allow the intake of iodine in a more regulated manner and the gradual increase at the level to ensure iodine sufficiency, with the objective of alleviating the risk of IIH.

In contrast, a voluntary fortification program was reported to emphasize on monitoring at several levels like iodine in salt, iodine in the food with iodised salt and of iodine intake and thyroid disorders in the population before and during the fortification period. Next, the interference of stakeholders would accelerate the progress of various policy options on salt intake. The stakeholders may be ministry of health-public health, national food safety agencies/ public health institutes, ministry of education- interventions in schools and universities, research universities and academia, ministry of science and technology, ministry of information and communication, regional and local governments, municipalities, schools, hospitals and prisons administrations, legislators, public food an nutrition research institutes (WHO report, 2007).

From the private sector, food and non alcoholic beverage producers, spices, condiments, sauces and food preservative producers, catering industry, restaurants and bars, special interest groups ( industry groups, business, trade organizations), apex organizations of commercial groups, commercial sector organizations, commercial sector, salt producers and miners, retailers, advertising industry, private schools and hospital administrations, media and press (WHO report, 2007). Others include community groups, health promotion organizations, food safety organizations, health professional associations, education organizations, parent teacher associations, micronutrient interest groups etc (WHO report, 2007). At the international level, the stake holders are, WHO, UNICEF, Codex Alimentarius, European Commission, Regional economic groupings, international research institutes (WHO report, 2007).

Analysis of policy approach

There is a need to analyze the available policy options by considering the following principles. The policies or interventions that are worth implementing should not be authorized without the inclusion of mechanism for regular evaluation (WHO report, 2007). Monitoring and evaluation should be incorporated into the planning, design and implementation process and appropriate budget should be included for evaluation activities (WHO report, 2007).

Monitoring and evaluation should programs need to be defined during the program design which would help in facilitating the availability of baseline data and planning of the initial surveys/ assessments such that they would be used for monitoring in the future. There help of statisticians, economists for cost –benefit and cost –effectiveness analysis, programme manager for determining the risk should be evaluated. The results obtained from the evaluation need to be spread in the community (WHO report, 2007). Further, the policies and interventions should include process evaluation to determine whether the implemented program is planned (WHO report, 2007).

This would enable the stakeholders to identify the limitations and improve the implementation of policies by identifying, testing and implementing corrective measures (WHO report, 2007).

Similarly, there is a need to evaluate the outcome to determine whether the proposed outcomes have been obtained as result of the policy implementation (WHO report, 2007).

The results from this outcome evaluation strategy need to be utilized as a tool for advocacy and raising awareness, particularly of key decision and policy- makers(WHO report, 2007).. Finally, during the evaluation process, ongoing activities need to be considered and efforts should be made to harmonize with them and other programs, existing institutions, earlier data and available indicators (WHO report, 2007).

However, there is also a need to determine the adverse affects of high salt intake on health in order to understand the significance of policy options and their analyses.

It was reported that a condition known as Hypernatremia was strongly linked to high sodium intake although occurrence rates are low (Moder and Hurley,1990)There were nearly 30 patients (10 adult and 20 pediatric cases) reported with exogenous salt intake who had hypernatremia (Moder and Hurley,1990) Here, initial serum sodium concentration and the age of patient were considered to be the most important prognostic indicators (Moder and Hurley,1990).In certain situations this condition could also lead to death which is the case with old patients of nearly 41 year (Moder and Hurley,1990). In contrast, the survival rates are much better for very young patients and those with lesser degrees of hypernatremia (Moder and Hurley, 1990).

Hence this report has suggested the indications that are likely to occur following an imbalanced salt intake. Selmer et al. (2000) described the importance of strategies intended to minimize daily salt consumption at the rate of 6 g per person in a Norwegian study. Much emphasis was given to programs like health promotion (information campaigns), declaration of salt content in food and taxes on salty food/subsidies of products with less salt and development of new industry food recipes (Selmer et al., 2000).

They have also monitored blood pressure and other parameters like cost of the interventions welfare losses from taxation of salty food / subsidizing of food products with little salt, cost of avoided myocardial infarction and stroke treatment, cost of avoided antihypertensive treatment, hospital costs in additional life years and productivity gains from reduced morbidity and mortality (Selmer et al., 2000). They have found that a reduction in systolic blood pressure than 2 mm Hg would save the cost that would be incurred by high salt intake. Hence, it was mentioned that strategies to lessen the salt intake are having good future implications on public health and costs (Selmer et al., 2000).

Reducing Salt consumption has also been connected to a decreased risk for cardiovascular disease (Dickinson and Havas, 2007). It was reported that in many populations salt consumption was directly related to the prevalence of hypertension associated with level of blood pressure, and the gradual rise in blood pressure with age (Dickinson and Havas, 2007).This was revealed in a random controlled study where the majority of sodium consumption was found to be obtained from the quantities added during food processing and preparation (Dickinson and Havas, 2007).The intake of sodium has become a much concern and to this end approximately 6000 mg of salt equivalent to 2400 mg or less was recommended by scientific organizations and governmental authorities (Dickinson and Havas, 2007).

This resulted in a decrease in overall blood pressure distribution. The main reason would be that a low intake of 1.3-g/d would convert into nearly 5-mm Hg smaller rise in systolic blood pressure as an individual’ age increases from 25 to 55 years of age (Dickinson and Havas, 2007).This would drastically lead to a decrease, enough to save 150,000 lives per year. Hence, there is need of stringent rules in order to meet the hygienic requirement of lower sodium concentrations in processed and prepared foods (Dickinson and Havas, 2007).

This could be achieved with a concerted effort from food industries, consumer education and awareness regarding the use of food labels keeping in view of the consequences of high salt intake (Dickinson and Havas, 2007).

Next, it was reported that diet enriched with salt has links with evolutionary norms (Frassetto et al., 2008). This is the case with a typical American diet which contains larger amounts of foods that are metabolized to noncarbonic acids than to organic bases (Frassetto et al., 2008).However, the effect of sodium intake on health problems was better correlated with a combined sodium and potassium levels (Frassetto et al., 2008)

In other words, the inverted ratio of potassium to sodium in the diet when compared with preagricultural diets was reported to influence cardiovascular function adversely leading to hypertension and stroke (Frassetto et al., 2008).Hence, it was emphasized that diet should be modified in order to achieve its evolutionary norms where lessening the sodium chloride consumption was given the prior importance followed by encouraging the intake of potassium-rich net base-producing fruits and vegetables for maintenance of energy balance (Frassetto et al., 2008). Hence, this report has indicated the need of reducing salt consumption in a typical American diet.

It is reasonable to mention that above guidelines if followed in other countries nay help in reducing the burden of health problems associated with high salt intake. But this may in turn depend on socio-economic position.

Scientists have emphasized the association between education and food purchasing attitude and the contribution of dietary awareness to the association; connection between salaries and purchasing attitude and the contribution made by the individual perceptions about the cost of healthy food (Turrell and Kavanagh, 2006).

Analysis of policy setting

The analysis of policy setting is important as it would reveal the socio-economic differences in food purchasing attitude that are more likely to contribute to the association between socio-economic position and food and nutrient intakes and also to the socio-economic health inequalities for diet-related disease (Turrell and Kavanagh, 2006).Therefore, general population should realize the importance of socio-economic differences that might influence the dietary knowledge and concerns about the cost of healthy food (Turrell and Kavanagh, 2006).

This could help in understanding the vital relationships that ensure a future health promotion strategies aimed at minimizing health inequalities (Turrell and Kavanagh, 2006).

The intake of salt on blood pressure is an important scientific aspect to explore. This is because much of the complaints related to cardiovascular disease have roots linked with salt intake. Since the burden of disability and cardiovascular induced fatal conditions is increasing globally, much priority was given to study of blood pressure as risk factor for this disorder in developing countries (Mac Gregor and He, 2005).

The strategies highlighted were reducing dietary salt intake and enhancing the vegetables and fruit consumption. Experimental studies on blood pressure lessening have also revealed its significance in reducing the risk of strokes, heart failure and coronary heart disease (Mac Gregor and He, 2005).Drugs like Thiazide diuretics are reported to be reliable as they minimize blood pressure and have been considered to be the most widely preferred drugs of choice (Mac Gregor and He, 2005).This could be because they have the potential to enable water sodium and potassium to lose (MacGregor and He, 2005).

Hence, it can be inferred that drugs that work on the sodium -potassium channels may help in lowering blood pressure provide there is a concomitant low salt intake. This concept has strengthened a recent description that described high blood pressure is the major risk contributor of death globally which is in turn connected to High dietary salt(Mohan and Campbell, 2009).

Health care professionals play vital role as stakeholders. They have undertaken good number of population based studies in order to disseminate the research information on salt intake.

Therefore, the potential link between population-based strategy and dietary salt intake has been a considerable research policy interest in many countries. This was revealed from several animal, epidemiology and human intervention studies (Mohan and Campbell, 2009).WHO (World Health Organization) guidelines indicate that population-wide salt consumption should be lessened to less than 5 g/day(Mohan and Campbell, 2009). In order to achieve this, a joint venture program between governments, the food industry, scientific organizations and healthcare organizations is essential (Mohan and Campbell, 2009).

Similarly, it was found that in Portugal there was high salt intake diet, and prevention steps were set up to limit salt consumption in order to prevent and treat hypertensive disease and to lessen the cardiovascular risk (Polónia et al., 2006).

This was revealed when a cross-sectional study was undertaken to determine the levels of sodium, potassium and creatinine in a 24-hour urine followed by other parameters like blood pressure (BP), and pulse wave velocity (PWV) as an index of aortic stiffness in adult individuals of sustained hypertensives (HT), with regard to their routine dietary habits (Polónia et al., 2006).

In a South African study, similar efforts were put to study the diagnosis and management of hypertension keeping in view of reduction in sodium (Na(+)) intake levels and increase in potassium (K(+)) intake levels which are the critical components of blood pressure (BP) control.

They have assessed mean 24-hour urinary Na (+) and K(+) excretion rates, made a comparison with the recommended daily allowances (RDA) for Na(+) and K(+) intake in an urban, developing community (Maseko et al., 2006).

On the other hand, the workers also determined the relationship between hypertension awareness and treatment, and 24- hour urinary Na (+) and K (+) excretion rates (Maseko et al., 2006). They reported that there is dearth of connection between either hypertension awareness and treatment, and Na(+) and K(+) intake levels. Therefore, this has indicated a failure of implementing the strategies in the clinical practice in urban and developing communities for a reduced Na (+) and increased K (+) intake in hypertensives (Maseko et al., 2006). Further, it was reported that sodium chloride present in salt has the potential to produce 50 – 100 % of acidosis of the diet which could be considered as a typical net acid-producing diet (Frassetto et al., 2007).This is an index that reflects steady-state renal net acid excretion rate (NAE) (Frassetto et al., 2007).

Here the parameters that are analyzed are blood hydrogen ion concentration ([H]b), plasma bicarbonate concentration ([HCO(3)(-)]p), the partial pressure of carbon dioxide (Pco(2)), the urinary excretion rates of Na, Cl, NAE, and renal function as measured by creatinine clearance (CrCl) (Frassetto et al., 2007).The results indicated the diet loads of NaCl and net acid predict systemic acid-base status in an independent manner in healthy individuals.

The increase in load produces increasing degrees of low-grade hyperchloremic metabolic acidosis (Frassetto et al., 2007).Hence the intake of salt need to be strictly monitored and regulated in population suspected of acidosis.

He and Mac Gregor (2009) reported that salt reduction programs that are in progress keeping in view of global incidence of mortality rates caused by Cardiovascular disease (CVD). Here, smoking, raised blood pressure (BP) and cholesterol were considered as the major risk factors (He and Mac Gregor, 2009). It was revealed that high BP constituted for 62% of strokes and 49% of coronary heart disease. The adverse affects of high salt intake has also shed light on left ventricular hypertrophy and renal disease, obesity through soft drink consumption, associated with renal stones and osteoporosis and stomach cancer(He and Mac Gregor,2009).

Much priority was given in advanced countries by strategies focusing on reduction in salt intake by monitoring amount of salt added to food by the food industry (He and Mac Gregor,2009). In contrast, in low economic or developing countries cooking or sauces contribute to the important sources of salt consumption. Hence, a population based general health campaigns would be required to encourage consumers to restricted salt diet (He and Mac Gregor, 2009).

So, the countries that implemented programs on reduced salt intake are Japan (1960-1970), Finland (1975 onwards) and recently the United Kingdom(He and Mac Gregor,2009).The ultimate aim of this intervention is to successful implementation worldwide for the betterment of the mankind (He and Mac Gregor, 2009).

Recently, it was described that global consumption of salt is more than the normal accepted range of 10-20 mmol/day. Here, the sources such as cereals and baked goods were identified as the major contributor to dietary sodium intake especially in UK and US adult population. In Asian countries of Japan and China, salt addition at cooking and soy sauce were considered as the major sources (Brown et al., 2009).The mean sodium intakes are >100 mmol/day, and for many Asian countries the mean intakes are >200 mmol/day.

The countries that are excluded in this category are Cameroon, Ghana, Samoa, Spain, Taiwan, Tanzania, Uganda and Venezuela (Brown et al., 2009).This is because the strategies that were implemented are far below the national standards to represent. However, sodium added in manufactured foods is very high in European and Northern American countries (Brown et al., 2009). This may indicate that, the policy setting has improved only in some countries.

There were unusually increased sodium intakes globally contributing to the rising prevalence of salt induced problems (Brown et al., 2009).Sources of dietary sodium vary largely worldwide. Hence, policy makers should focus on the principal source of dietary sodium in the various populations in order to reduce salt consumption among population (Brown et al., 2009). Next, there is also a need to determine the connection between dietary salt and fluid intake (He, Marrero & Mac Gregor, 2008).This association was emphasized in children where Sugar-sweetened soft drink consumption was reported to be linked to childhood obesity(He, Marrero & Mac Gregor, 2008).

To this end, researcher have found that a difference of 1 g/d in salt intake was associated with a difference of 100 and 27 g/d in total fluid and sugar-sweetened soft drink consumption, respectively(He, Marrero & Mac Gregor, 2008). Therefore, a decreased salt consumption might be helpful in lessening the risk of childhood obesity and its impact on sugar-sweetened soft drink consumption (He, Marrero & Mac Gregor, 2008).

This strategy could also minimize the risk of cardiovascular disease and chances of increased blood pressure (He, Marrero & Mac Gregor, 2008).There are certain issues to be answered regarding the beneficial or harmful affects of dietary sodium consumption. The important area is the field of hypertension where the high salt intake and clinical outcome are the main factors to be addressed (Thijssen, Kitzler & Levin, 2008).

Similarly, the impact of high salt intake in patients with chronic kidney disease (CKD) is another important matter of concern (Thijssen, Kitzler & Levin, 2008).This is because it is properly known whether any risk would be associated with salt balance in CKD patients (particularly at K/DOQI stage 5) or salt-mediated pathophysiology. Hence, there is need to suggest reduced dietary salt intake in this patient population (Thijssen, Kitzler & Levin, 2008).

The other health problems likely to occur with high salt consumption are hypernatraemia in children which has poor diagnosis rate in healthy elderly persons (Orfan et al., 2004).This was when 20-year-old lady suffered of post-natal depression and consumed large amount of salt as part of exorcism ritual. She ultimately developed fatal salt poisoning (Orfan et al., 2004). The findings are highest ever documented serum sodium level of 255 mmol L(-1), associated with severe neurological impairment (Orfan et al., 2004).

The patient condition was not recovered even after a aggressive hypotonic fluid replacement. This case had drawn the attention of scientists and this had led to a review of extensive medical literature and retrieval of 16 previous cases of severe hypernatraemia in adults secondary to excessive salt ingestion (Orfan et al., 2004).The most common symptoms were underlying cognitive or psychiatric disorders in nearly 95 % of females (Orfan et al., 2004).

Therefore, the utility of salty beverages as emetics or as part of ‘exorcism’ rituals need to be strictly controlled with awareness programs with special emphasis on risk contributing actors (Orfan et al., 2004). Salt consumption is better associated with the function of kidneys (Krzesinski and Cohen, 2007). This is because their contribution is central in regulating the salt balance and blood pressure (Krzesinski and Cohen, 2007).

In most patients with hypertension salt sensitivity is known to occur either acquired or genetically predisposed in nearly 50% of patients with essential hypertension (Krzesinski and Cohen, 2007).

As such, this tendency would contribute to increased risk for cardiovascular disorders. Here, salt levels are tightly regulated which is a good hygienic sign which is in turn associated with high potassium intake (Krzesinski and Cohen, 2007). The confined salt levels are important to control the blood pressure in patients responding to antihypertensive drugs. This also enables the need of repeated prescription of medication otherwise required for restoring a normal blood pressure. It was described that the maximal salt intake should be within 6 grams/day (NaCl) (Krzesinski and Cohen, 2007). Therefore, it is the responsibility of food industries that supply processed food to meet the regular demands of dietary salt, to play important role in minimizing the risk for cardiovascular disease (Krzesinski and Cohen, 2007).

However, there is also a need to connect this part of description with the plasma sodium concentrations (He et al., 2005). This is because individuals with high blood pressure have a faulty mechanism to expel the salt levels out of the body (He et al., 2005).The ultimate result is the ability of kidneys to retain sodium levels and an increase in blood pressure becomes a compulsory event (He et al., 2005).Researchers have described a fall in plasma sodium which was found to be correlated with the fall in systolic blood pressure (He et al., 2005).

Therefore, a rise or fall in the dietary salt levels would lead to corresponding changes in plasma sodium which in turn induces changes in extracellular volume, which may influence blood pressure (He et al., 2005). On the whole, cross-country analysis at Child care, nephrology and cardiovascular settings may help in the thorough analysis of policies under implementation.

Recommendations for policy

In view of the above information, there are certain decisions to be taken or recommended. Initially, there is a need to implement the mandatory utility of iodised salt in most breads, but it is also important to ensure that the significance of reducing salt intake is communicated precisely to both the food industry and consumers in any manner about the use of iodised salt. There is a need to guarantee that the accompanying educational campaign neither promotes nor requires the use of added salt at the table and/or cooking. They should also ensure that supplements and other sources are promoted to those for whom the mandatory use of iodised salt in bread will not ensure that they receive sufficient dietary iodine.

There is a need to carry out a long-term monitoring system to assess the impact on iodine status across various population groups regarding the mandatory use of iodised salt in bread, government should provide financial support for industries to develop alternative strategies of delivering iodine to the population.

Large population screening needs to be carried out at household levels. This requires a collaboration between health care professionals and society representatives. The utility of questionnaires, telephonic interviews is a must for obtaining concrete information from house holders. Here, much focus should be given to awareness programs on the adverse effects of salt consumption among population such that a reduced dietary salt intake should become the mandatory aspect.

Policy makers should interact with the health care researchers to assess the status of hypertension, blood pressure levels in individuals at risk of acquiring diseases like cardiovascular disease, obesity, hypernatraemia etc. The association between high salt intake and blood pressure should be highlighted on labels of food products that may gain entry into tables of domestic kitchens.

Mechanisms underlying the risk associated with high salt intake need to be thoroughly studied to understand the pathogenesis of salt induced unhygienic conditions. Various biochemical parameters, for example, plasma sodium levels, that give a direct index of salt consumption need to be determined. The need of nephrologists should not be overlooked. This is because of the strong connection between the salt metabolism and kidneys.

The recommendations or guidelines issued by food authorities need to be thoroughly followed by the food industries keeping in view of the accepted range of sodium intake. Therefore, the reduction of salt consumption among population would become reality provided cross-nation studies are carried out, data interpreted and intervening programs implemented from the grass root level.

References:

Brown, IJ, Tzoulaki, I, Candeias, V, Elliott, P. (2009). ‘Salt intakes around the world: implications for public health’ Int J Epidemiol, 38(3):791-813.

Dickinson, BD, Havas, S. (2008). ‘Reducing the population burden of cardiovascular disease by reducing sodium intake: a report of the Council on Science and Public Health.’ Arch Intern Med, 168(3):332.

Dietary association of Australia Submission to FSANZ re P230 Iodine Fortification (2005). Web.

Frassetto, LA, Morris, RC Jr, Sebastian, A. (2007).’Dietary sodium chloride intake independently predicts the degree of hyperchloremic metabolic acidosis in healthy humans consuming a net acid-producing diet’. Am J Physiol Renal Physiol, 293(2):F521-5.

Frassetto, LA, Morris, RC Jr, Sellmeyer, DE, Sebastian, A. (2008). ‘Adverse effects of sodium chloride on bone in the aging human population resulting from habitual consumption of typical American diets.’ J Nutr, 138(2):419S-422S.

He, FJ, MacGregor, GA (2009). ‘A comprehensive review on salt and health and current experience of worldwide salt reduction programmes.’ J Hum Hypertens, 23(6):363-84.

He, FJ, Markandu, ND, Sagnella, GA, de Wardener, HE, Mac Gregor, GA. (2005). ‘Plasma sodium: ignored and underestimated’. Hypertension, 45(1):98-102.

He, FJ, Marrero, NM, MacGregor, GA. (2008). Salt intake is related to soft drink consumption in children and adolescents: a link to obesity? Hypertension,51(3):629-34.

Krzesinski, JM, Cohen, EP. (2007). ‘Salt, the kidneys, and arterial hypertension’. Acta Clin Belg 62(5):348-57.

Lozada, M, Sánchez-Castillo, CP, Cabrera Gdel, A, Mata, Pichardo-Ontiveros, E, James WP. (2007). ‘Salt: its goodness and perversities’. Rev Invest Clin, 59(5):382-93.

Mac Gregor, GA, He, FJ.(2005). Importance of controlling blood pressure. Climacteric. 3:13-8.

Maseko, MJ, Majane, HO, Milne, J, Norton, GR, Woodiwiss, AJ. (2006). ‘Salt intake in an urban, developing South African community’. Cardiovasc J S Afr, 17(4):186-91.

Medeiros-Neto, G.Iodine nutrition in Brazil: where do we stand? Arq Bras Endocrinol Metabol,53(4):470-4.

Moder, KG and Hurley, DL. (1990). ‘Fatal hypernatremia from exogenous salt intake: report of a case and review of the literature.’ Mayo Clin Proc, 65(12):1587-94.

Mohan, S, Campbell, NR. (2009). ‘Salt and high blood pressure.’ Clin Sci (Lond), 117(1):1-11.

Ofran, Y, Lavi, D, Opher, D, Weiss, TA, Elinav, E.(2004). ‘Fatal voluntary salt intake resulting in the highest ever documented sodium plasma level in adults (255 mmol L-1): a disorder linked to female gender and psychiatric disorders’. J Intern Med, 256(6):525-8.

P1003 AWASH submission May 2008. Web.

Pearson, AM and Wolzak, AM (1982). ‘Salt-its use in animal products- a human health dilemma.’ J Anim Sci, 54(6):1263-78.

Polónia, J, Maldonado, J, Ramos, R, Bertoquini, S, Duro, M, Almeida, C, Ferreira, J, Barbosa, L, Silva, JA, Martins, L. (2006). ‘Estimation of salt intake by urinary sodium excretion in a Portuguese adult population and its relationship to arterial stiffness.’ Rev Port Cardiol, 25(9):801-17.

Reducing salt intake in population: report of a WHO forum and technical meeting, 2006,Paris, France.

Selmer, RM, Kristiansen, IS, Haglerod, A, Graff-Iversen, S, Larsen, HK, Meyer, HE, Bonaa, KH, Thelle, DS. (2000). ‘Cost and health consequences of reducing the population intake of salt. J Epidemiol Community Health, 54(9):697-702.

Thijssen, S, Kitzler, TM, Levin, NW. (2008). Salt: its role in chronic kidney disease.J Ren Nutr,18(1):18-26.

Turrell, G, Kavanagh, AM.(2006). ‘Socio-economic pathways to diet: modelling the association between socio-economic position and food purchasing behavior.’ Public Health Nutr, 9(3):375-83.

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