Professional Documents
Culture Documents
Presenters name
Institution
Outline
Hypertension:
A leading risk factor for death
and disability
Attributable Mortality
(In millions; total 55,861,000)
Ezzati et al. WHO 2000 Report. Lancet. 2002;360:1347-60.
Risk of hypertension
increases with age
Risk of Hypertension %
Risk of Hypertension %
100
100
Women
80
80
60
60
40
40
20
20
10
12
14
Years to Follow-up
16
18
20
Men
10
12
14
16
18
20
Years to Follow-up
In summary
11
12
CVD
Death
All
Death
1.75
Hazard Ratio
1.50
High salt
intake
1.25
1.00
Lower salt
intake
0.75
0.50
He FJ, MacGregor GA. J Hum Hypertens. 2002;16:761-70.
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is a health risk
WHO/FAO technical report recommends
less than 5 g of salt per day
Nishida C et al. Public Health Nutr. 2003;7:245-50.
14
15
16
17
Mortality
hypertensive encephalopathy
stroke
heart failure
premature death
18
Renal Mechanisms
for Salt-Dependent
Hypertension
20
21
22
23
24
Normotensives
-6
-8
Hypertensives
-10
-12
-30
-50
-70
-90
-110
-130
25
26
27
28
29
30
DASH diet
9 g/d salt
control level
- 6 mmHg
6 g/d salt
- 2 mmHg
- 7 mmHg
3 g/d salt
- 7 mmHg
- 9 mmHg
31
32
In summary
High dietary salt increases blood pressure, which
is a health risk.
33
The Importance of
Lower Salt Intake
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35
36
37
3360 mg
DBP
Salt
Stroke
38
39
R=0.40
p<0.001
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41
42
DRI, IM 2003
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11%
12%
77%
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In summary
In the Americas, people consume an unhealthy
amount of salt.
This can cause hypertension, a leading risk for
death and disability.
The solution is to reduce salt in commercially
manufactured food and promote healthy eating.
We need to educate the public and patients.
We need to provide leadership in our
communities.
The outlook for improvement is cautiously
optimistic.
49
Key messages
Dietary salt is an important contributor to high
blood pressure.
Reducing salt lowers blood pressure and
prevents cardiovascular disease.
Salt intake in the Americas is higher than the
levels recommended for health.
50
Key messages
Policies to reduce population-wide salt
intake are most effective and can have a
high impact.
Healthcare professionals can play a key role
in educating people of all ages regarding
their optimal dietary salt intake.
51
UK (1996)
Food Standards Agency
http://www.food.gov.uk/healthiereating/salt/
http://www.worldactiononsalt.com/
52
Global initiatives
Success of WASH raising public, political and
manufacturers awareness
WHO Technical Meeting statement on Reducing
salt intake in populations
Agreement of major global food and beverage
manufacturers to cut salt in their foods products
World Hypertension Day 2009 theme Salt and
Hypertension a massive global public health
campaign to reduce dietary salt through a variety
of initiatives including food sector and other
stakeholders participation
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Anticipated outcomes
increased consumer awareness of the health
dangers of high dietary salt
increased consumer demand for lower salt foods
increased development of lower salt foods by the
food sector
increased government monitoring of dietary salt
as a health parameter
gradual reduction in dietary salt such that most
people are below the upper limit (by 2020)
55
PAHO/WHO
Cardiovascular Disease Prevention
through Dietary Salt Reduction
56
PAHO/WHO
Cardiovascular Disease Prevention
through Dietary Salt Reduction
PAHO has established a Regional Experts
Group
international leaders in nutrition and chronic
diseases
developed a policy statement
with a view to commitment and implementation by
stakeholders
who is willing to do what
what resources are required
57
Policy Goal
A gradual and sustained drop in dietary salt intake to
reach national targets or the internationally
recommended target of less than 5g/day/person by
2020.
To national governments
Seek endorsement for the PAHO dietary salt
reduction policy statement from ministries of
health, agriculture and trade, from food
regulatory agencies, national public health
leaders, non-governmental organizations,
academia, and relevant food industries.
59
To national governments
Develop sustainable, securely funded, scientifically
based salt reduction programs that are integrated into
existing food, nutrition and health education programs.
The programs should be socially inclusive and include
major socioeconomic, racial, cultural, gender and age
subgroups and specifically children. Components should
include:
Standardized food labels that easily identify high and
low salt foods.
Educating people including children about the health
risks of high dietary salt and how to reduce salt intake
as part of a healthy diet.
60
To national governments
Initiate collaboration with relevant domestic food
industries to set gradually decreasing targets, with
timelines, for salt levels according to food categories,
by regulation or through economic incentives or
disincentives with government oversight.
Regulate or otherwise encourage domestic and
multinational food enterprises to adopt a) best in
class (salt content to match the lowest in the specific
food category) and b) best in world (salt content to
match the lowest in a specific food produced by the
company elsewhere in the world) formulations for
products in national markets.
61
To national governments
Develop a national surveillance system with
regular reporting of dietary salt intake levels
and the major sources of dietary salt. Monitor
progress towards reducing intake to the reach
the international target or a national one.
62
To national governments
Review national salt fortification policies and
recommendations to be in concordance with the
recommended salt intake.
Extend official support to the Codex Alimentarius
Committee on Food Labeling for salt/sodium to be
included as a mandatory component of nutrition
labels.
Develop legislative or regulatory frameworks to
implement the WHO recommendations on advertising
of food products and beverages to children.
63
To nongovernmental organizations,
healthcare organizations, associations of
health professionals, consumers
associations
Broadly disseminate relevant literature.
Educate policy and decision makers on the health
benefits of lowering blood pressure among
normotensive and hypertensive people, regardless of
age.
Advocate policies and regulations that will contribute
to population-wide reductions in dietary salt.
Promote coalition-building, increase organizational
capacity for advocacy and develop advocacy tools to
promote civil society actions.
65
66
To PAHO
Ensure good communications and information sharing
between regional and international initiatives to foster best
practices.
Develop a template for national report cards and report to
Member States on comparative national baselines and
progress at pre specified time points (e.g. in 2010 the
baseline, progress in 2015 and 2020).
Work with Member States to monitor dietary salt
consumption.
Develop and foster a network of endorsing governments,
NGOs, and expert champions on dietary salt in the region.
Develop a web based toolbox with educational materials
and programs on dietary salt for the public, patients,
healthcare professionals that are culturally appropriate to
subregions of the Americas.
67
To PAHO
Develop and advocate conflict of interest
guidelines to assist health organizations and
scientists in the region in their interactions with
the food industry.
Foster research on the economic and health
impacts of high dietary salt in the countries and
sub-regions.
Assist Member States to revise national and
subregional fortification programs to be
consistent with efforts to reduce dietary salt.
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To PAHO
Collaborate with FAO, UNICEF, the Codex
Alimentarius Commission and other relevant UN
bodies to achieve a consistent and coordinated
approach to reducing dietary salt.
Educate policy and decision-makers on the
health benefits of lowering blood pressure among
normotensive and hypertensive people,
regardless of age.
Advocate policies and regulations that will
contribute to population-wide reductions in
dietary salt.
69
www.lowersodium.ca
www.sodium101.ca
Hypertension website
www.hypertension.ca
Consensus Action on Salt & Health (CASH)
www.actiononsalt.org.uk
World Action on Salt &Health (WASH)
www.worldactiononsalt.com/
World Health Organization (WHO)
www.who.int/dietphysicalactivity/reducingsalt/en
Pan American Health Organizaiton (PAHO)
www.paho.org/cncd_cvd/salt
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Resources
71
Resources
WHO Forum on Reducing Salt Intake in
Populations (2006: Paris, France)
Reducing salt intake in populations:
Report of a WHO Forum and Technical
Meeting.
5-7 October 2006, Paris, France.
1.
2.
3.
4.
5.
I.
II.
III.
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