Study On Salt Reduction Strategy For China

BackgroundHypertension has become a major public health problem in our country. Salt reduction has been proven to be the most cost-effective population policy of prevent and control high blood pressure, and widely recognized internationally. Salt intake level of Chinese population has been high. Although the China chronic disease prevention and control planning has put for-ward a clear salt reduction targets, but our salt reduction and hypertension prevention and control work is still in its initial and exploratory stage. There is still lack of clear strategies and measures, and there is not yet in-depth qualitative analysis and a systematic study. It is necessary to further investigate the implementation of the strategies and methods of salt re-duction to prevention and control of hypertension. Our salt reduction research will provide a scientific basis and significance promote China’s salt reduction work.ObjectivesThrough salt reduction and hypertension-related research work among study population, and to understand slat reduction knowledge, attitudes and behavior of family chef, catering and food production enterprise key person and its main influencing factors, and to analysis salt reduction hinder the work and the promotion of factors, and to seek the strategy and recom-mendations for salt reduction in China.Subjects and methodsThis study carried out the investigation combining the qualitative survey and quantitative survey. Quantitative survey data from the2011baseline survey of Shandong&Ministry of Health Action on Salt and Hypertension project, including1508population surveys and phys-ical measurements,213dietary survey,191the24-hour urine sodium data in Yantai, and questionnaires data of1072catering units,434food production enterprises and626pre-packaged food laboratory test data in Shandong province. We selected key areas and key populations to conduct qualitative research, including30family chefs groups discussion,28chefs and key person personal interviews among15catering units,14managers and research-ers personal interviews among7food production enterprise. Meanwhile we collected and or-ganized the literature about salt reduction policy information, and carried out SWOT analysis. This study used questionnaires, physical measurements, dietary surveys,24-hour urine, group discussion, individual interviews, literature review and other data collection methods. Data-base was build through EpiData3.1and Excel2007software. SAS9.3software was used in analysis. Descriptive statistical analysis, multivariate analysis methods, thematic framework analysis, SWOT analysis were used for analyzing of data.Results1. The amount of individual dietary sodium intake was6087mg, mainly derived from condi-ments5001mg (82.2%),grains593mg(9.7%),fish155mg(2.6%). Sodium from processed food was586mg accounted for9.6%of the total sodium intake. The mean Na, K and Na:K outputs over24hours were201.5±77.7mmol/day,46.8±23.2mmol/day and4.9±2.2, respectively. Overall,92.1%of the subjects (96.9%of men and87.1%of women) had intakes of over6g salt (NaCl)/d. After adjusting for sex, age, and BMI,24-hour urinary sodium and systolic blood pressure was positively correlated. Each100mmol/d (6g/d salt) increase in sodium in-take was associated with a4.0mmHg increase in systolic blood pressure.2. The prevalence of hypertension was25.1%. The awareness rate of hypertension24.9%, The treatment rate was19.1%.The control rate was9.5%. The awareness rate of diagnostic criteria of hypertension was36.5%. The awareness rate of6grams of salt per day was22.8%. Con-cerns rate of sodium was8.2%, self-evaluation rate of excess salt was20.1%, and approv-al rate of low salt diet was90.8%. The willingness rate of intend salt reduction was86.3%. The behavior rate of salt reduction was34.2%. Awareness, willingness, married people and women were affect behavior of salt reduction. Qualitative research found that the majority of residents less salt consciousness. Two main reasons were affect the taste and fluke mind. Changing eating habits, salt restriction tools inconvenience, higher low-sodium salt prices were affected reduction measures implementation.3. The average per person salt, soy sauce, sauce, monosodium consumption in catering units were6.4g,7.1g,2.4g and2.0g, respectively. The minimum consumption was canteen. The awareness rate of diagnostic criteria of hypertension was62.5%. The awareness rate of6grams of salt per day was62.0%.The awareness of slat and hypertension was higher in cater-ing units. The willingness rate of intend salt reduction was92.3%. Qualitative study found most chefs add salt according to experience, and do not know the specific amount."The food taste to make the customer satisfied" is the catering unit chief priority. The motivation of salt reduction was not high in catering units. The main reasons were fear of affecting tourists and efficiency. Cooking less salt is no difficulty for the chefs, but mainly to meet customer needs.4. The average amount of salt was2%in nine categories of food production enterprises. The average amounts of salt in condiments and pickles enterprises were12%and7%. Salt content in soy sauce, pickles and sauce were higher among available pre-packaged food. The aware-ness rate of diagnostic criteria of hypertension was79.9%. The awareness rate of6grams of salt per day was73.9%. The willingness rate of intend salt reduction was89.6%, but39%of business executives believe that you cannot reduce the salt content. Qualitative study found that key person in food companies were more concerned about food sodium content. The main reasons were affect taste and sales, have uncertain risk. There were many difficulties in reducing salt, including the restriction of health standards, undefined low-salt food, and lack of social environment.5. The SWOT analysis of salt reduction initiatives found that:①Strengths:Effectively action; comply with the health policy; most cost-effective population strategy.②Weakness:Chang-ing taste is difficult, and our salt reduction technology conditions need to be improved.③Opportunities:International and domestic policy supports; the increasing health need among the residents; foreign successful experience; chronic diseases prevention and control system has been initially formed,④threatens:Awareness of salt reduction was still lower; region-al differences in dietary habits in china; catering and food enterprises pursuit economic bene-fit; it is difficult to form multi-sectoral participation mechanism.ConclusionsThe amount of individual sodium intake was at a high level. The main source of sodium was still family cooking, but catering units and processed food are becoming important sources. The awareness of core knowledge of salt reduction was very low, and most people don’t real-ize their excess intake salt. The willingness of salt reduction in family chefs is higher, but the behavior rate of salt reduction was lower. Salt reduction initiatives and enthusiasm in catering units were not enough. Chef cooking less salt is not difficult, but the key is to meet the needs of customers. It is technically feasible that food production enterprise production low salt product, but still faces many difficulties. We should also increasing the low-diet awareness of consumer, and through market means to promote the catering units and food companies to reduce salt. Strategies and recommendations:1:Create a national level, the complete and effective salt reduction system and working me-chanism. Develop "action plan of salt reduction for China", set up "the national salt reduction working group".2:Establish an available monitoring and evaluation systems. Conduct exploring study of24hours urinary sodium; carry out the main dishes, pre-packaged food sodium monitoring, to assess the effects of salt process and reduction.3:Raising people’s awareness of salt reduction is fundamental policy, and health education and promotion should increase efforts."Hypertension diagnosis standard" and "6grams of salt per person per day" were the key information. Distribute salt supporting tools and focus on the correct use method.4:Catering industry should form a low-salt diet culture, and increase awareness of low salt among consumers in daily service. School and workplace canteens should reduce salt firstly.5:Implement nutrition labeling is a very important strategy, and we should further efforts to propagandize nutrition labels.Develop and improve the standard salt content of processed foods, and release healthy food labeling in appropriate time.