Preventing cardiovascular diseases by salt intake reduction in India

Abstract

Cardiovascular diseases (CVDs) are in the group of heart-related diseases which affect the heart and blood vessels. According to the World Health Organization (WHO), in 2015, CVDs led to 17.7 million deaths out of which about 75% of deaths occurred in LMICs. In India, CVD related mortality was 272 deaths per 100,000 in 2010, which was more than the average world mortality of 235 per 100,000 for the same year and mortality is expected to increase by about 111% by 2020. Hypertension (HTN) is one of the main causes of CVD, and according to WHO 2013 report, HTN caused 9.4 million deaths annually, which are more than the combined deaths from infectious diseases. In 2014, about 378.5 million Indian adults suffered from HTN which is 20% more compared to 2000. High salt consumption is one of the main cause of HTN. Although the recommended level of salt intake by WHO is 5g/day, in India the salt intake is about 13.8g/day. The factors, which affect the salt intake in India include: addictive nature of salt, inadequate labeling, misleading advertisements, wide availability and accessibility of salt, no salt restrictions by food manufacturers, lack of public knowledge and awareness, lack of access to healthy food, consumer behavior that could be influenced by consumers’ age, gender, income, occupation and SES. This is a complex social and medical issue which will require multiple strategies to be implemented. Potential interventions which may lead to a decrease in salt intake among Indians include: a) conducting comprehensive awareness raising campaign focusing on spreading awareness regarding the detrimental effects of high salt consumption through advertising, social media, and face-to-face sessions at the population level; b) comprehensive and consumerfriendly salt labeling legislation; c) enforcing taxation on food items with high sodium content; d) reformulating food products which contain a high amount of salt and persuading food manufacturers to decrease the high salt content in their products; e) engaging with the stakeholders (government, civil society, and media) for the implementation of the national salt reduction efforts; f) screening for HTN and body sodium content, annually, by health care workers will be helpful to monitor and provide feedback with the help of blood pressure (BP) measuring instruments and 24-hour urine salt analysis; and g) using salt substitutes like potassium chloride (KCl). Based on priority setting, the recommended course of action includes three strategies: a) comprehensive awareness raising campaign; b) food labeling; and c) product reformulation. For the measurement of the recommended strategies, the short term outcome will be assessed with the help of knowledge, attitude, and practice (KAP) questionnaires administered at the baseline and six months after the comprehensive educational campaign. For the assessment of the long-term impact, random urine samples will be collected to measure sodium content in urine with the help of twenty-four-hour urine analysis by healthcare professionals at baseline and annually for five years.