CHL 02-3 EVIDENCE AND INITIATIVES IN THE DIETARY SALT REDUCTION IN CHINA.

BACKGROUND: Salt reduction are crucial in the management of hypertension. Over the past few decades, Series of national activities and studies focusing on salt reduction and salt intake education were promoted by the Chinese government. However, the current status of dietary sodium and potassium intake of Chinese population is unclear.

OBJECTIVE: The aim of this study is to analyze the status of dietary salt and potassium intake in the Chinese population through summarizing the previous studies from 1998 to 2011 and then propose appropriate initiatives.

DESIGN: Relevant studies from 1998 to 2011 were considered for review if they satisfied the following criteria: 1) Papers reported on epidemiological survey or intervention observation conducted in Chinese participants; 2) Salt intake was estimated by urinary Na measurements, food weighted record method or food frequency questionnaire; 3) A stratified random sample is recruited, representative of participants aged over 15 years; 4) The sample size is larger than 200; 5) The participants do not have hypertension, stroke or other chronic diseases.

RESULTS: The average salt intake in Chinese residents dropped almost 30% from 15.24 g/d in 2000 to 10.6 g/d in 2010, while it was still higher than the recommended amounts by World Health Organization. The change of salt intake in northern and Southern China was respectively -3g/d and -0.5 g/d nearly ten years. Dietary salt intake in northern areas was still higher than in southern areas, but this gap between them became smaller. In urban and rural areas, the amount of Salt intake respectively decreased about 30% and 20% from 2003 to 2010. However the mean salt intake level was still higher in rural areas compared to urban areas (5.93 ± 1.90 g/d vs. 5.26 ± 1.72 g/d). In rural China, the major source of dietary sodium was added salt (69.7%), followed by soy sauce (8.5%), processed food (6.8%), and Monosodium glutamate (3.4%). Additionally, potassium intake did not change significantly among the past decade, the average dietary potassium intake is about 1.8 ± 0.7 g/d which is below the recommended standard, while the Na/K ratio decreased from 3.7 ± 2.2 in 2000 to 2.8 ± 1.8 in 2009.

CONCLUSIONS: Reducing sodium intake should be still a public health priority. According to sources of salt intake, sodium replacement and salt substitution might be feasible. Given potassium supplementation has an antihypertensive effect similar to that of salt restriction, replacing sodium with potassium in salt may be an effective way in blood pressure control in China. In addition, changing unhealthy eating habits through national health education is equally important to the implementation of salt reduction.