Eastern Mediterranean Salt Reduction Toolkit - World Action on Salt. Sugar & Health

In 2022, with the support of funding from Resolve to Save Lives, we worked with the WHO Regional Office for the Eastern Mediterranean to create a salt reduction toolkit to support policy makers and other stakeholders in the region to develop and implement public health initiatives to reduce population salt intake. Find out more about our work in the Eastern Mediterranean region.

Too much salt has a huge impact on health, leading to approximately 2 million deaths worldwide in 2019[1]. Excess salt consumption raises blood pressure and is linked to several non-communicable diseases (NCDs), including cardiovascular disease (CVD) and kidney disease[2]. CVD is the leading cause of death in the Eastern Mediterranean Region (EMR), with age-standardised CVD mortality rates considerably higher than the global average, especially in lower-income countries where access to healthcare is more limited[3]. The World Health Organization advises that adults should eat less than 5g of salt per day to reduce the risk of NCDs[4]. Globally, no country has yet met the recommended salt intake and in common with other regions, salt intake in the EMR is in excess of the recommendations, averaging more than 10g/day[5],[6].

Bread and dairy products have been found to be major contributors to salt intake in EMR countries, alongside processed meats, rice and cereal-based products, spices and condiments, salted fish, tomato pastes and eggs[7]. Significant social and economic changes in the Eastern Mediterranean have influenced diets in the region[8]. Countries that experienced rapid increases in household income at the beginning of the 21^st century, like Saudi Arabia, saw a nutrition transition with an overall increase in food supply[9]. Similarly, in some countries like Iran, the last four decades have seen major changes to the food system, with increased use of processed foods, due to industrialization and rapid urbanisation[10].

Salt reduction is a highly cost-effective strategy, identified by the WHO as a ‘best buy’ intervention[11]. This toolkit contains simple, practical and easy-to-use protocols. It has been designed to support WHO Country Office staff, counterparts and other stakeholders with a single source of information to gather essential baseline data, such as population salt intake, knowledge, attitudes and practices towards salt and sources of salt in population diets, and to guide the development of interventions to achieve salt reduction, including setting salt reduction targets, and innovative approaches to reducing salt levels in the out of home sector.

The salt action protocols were developed by World Action on Salt, Sugar and Health (WASSH), in close collaboration with the WHO Regional Office for the Eastern Mediterranean. The protocols build upon a similar set of documents that WASSH were commissioned to develop for the WHO Regional Office for South-East Asia. This project was conducted with the support of Resolve to Save Lives. Resolve to Save Lives is funded by grants from Bloomberg Philanthropies; the Bill and Melinda Gates Foundation; and Gates Philanthropy Partners, which is funded with support from the Chan Zuckerberg Foundation.

References

[1] GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: asystematic analysis for the Global Buren of Disease Study 2019. Lancet, 2020; 396(10258): 1223-12492

[2] He FJ, Tan M, Ma Y, MacGregor GA. Salt Reduction to Prevent Hypertension and Cardiovascular Disease: JACCState-of-the-Art Review. J Am Coll Cardiol. 2020;75(6):632-473

[3] Burden of cardiovascular diseases in the Eastern Mediterranean Region, 1990–2015: findings from the GlobalBurden of Disease 2015 study. Int J Public Health. 2018;63(Suppl 1):137–49

[4] Guideline: Sodium intake for adults and children. Geneva: World Health Organization, 2012

[5] Al Jawaldeh A, Rafii B, Nasreddine L. Salt intake reduction strategies in the Eastern Mediterranean Region. EastMediterr Health J Rev Sante Mediterr Orient Al-Majallah Al-Sihhiyah Li-Sharq Al-Mutawassit. 2019 Feb18;24(12):1172–80.

[6] Al-Jawaldeh A, Abbass MMS. Unhealthy Dietary Habits and Obesity: The Major Risk Factors Beyond Non-Communicable Diseases in the Eastern Mediterranean Region. Front Nutr [Internet]. 2022 [cited 2022 Dec 12];9.Available from: https://www.frontiersin.org/articles/10.3389/fnut.2022.817808

[7] Al Jawaldeh A, Rafii B, Nasreddine L. Salt intake reduction strategies in the Eastern Mediterranean Region. EastMediterr Health J Rev Sante Mediterr Orient Al-Majallah Al-Sihhiyah Li-Sharq Al-Mutawassit. 2019 Feb18;24(12):1172–80.

[8] Al-Jawaldeh A, Taktouk M, Nasreddine L. Food Consumption Patterns and Nutrient Intakes of Children andAdolescents in the Eastern Mediterranean Region: A Call for Policy Action. Nutrients. 2020 Nov;12(11):3345.

[9] Bin Sunaid FF, Al-Jawaldeh A, Almutairi MW, Alobaid RA, Alfuraih TM, Bensaidan FN, et al. Saudi Arabia’s HealthyFood Strategy: Progress & Hurdles in the 2030 Road. Nutrients. 2021 Jul;13(7):2130.

[10] Sobhani SR, Omidvar N, Abdollahi Z, Al Jawaldeh A. Shifting to a Sustainable Dietary Pattern in Iranian Population:Current Evidence and Future Directions. Front Nutr [Internet]. 2021 [cited 2022 Dec 12];8. Available from:https://www.frontiersin.org/articles/10.3389/fnut.2021.789692

[11] GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: asystematic analysis for the Global Buren of Disease Study 2019. Lancet, 2020; 396(10258): 1223-12492