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Salt intake and salt-reduction strategies in South Asia: From evidence to action.

ABSTRACT: The World Health Organization recommends salt reduction as a cost-effective intervention to prevent noncommunicable diseases. Salt-reduction interventions are best tailored to the local context, taking into consideration the varying baseline salt-intake levels, population's knowledge, attitude, and behaviors. Fundamental to reduction programs is the source of dietary salt-intake. In South Asian countries, there is a paucity of such baseline evidence around factors that contribute to community salt intake. Upon reviewing the electronic literature databases and government websites through March 31, 2021, we summarized dietary salt intake levels and aimed to identify major sources of sodium in the diet. Information on the current salt reduction strategies in eight South Asian countries were summarized, namely Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. One hundred twelve publications (out of identified 640) met our inclusion-exclusion criteria for full text review. Twenty-one studies were included in the review. Quality of the included studies was assessed using the US National Heart, Lung, and Blood Institute assessment tool. The primary result revealed that mean salt intake of South Asian countries was approximately twice (10 g/day) compared to WHO recommended intake (< 5 g/day). The significant proportion of salt intake is derived from salt additions during cooking and/or discretionary use at table. In most South Asian countries, there is limited data on population sodium intake based on 24-h urinary methods and sources of dietary salt in diet. While salt reduction initiatives have been proposed in these countries, they are yet to be fully implemented and evaluated. Proven salt reduction strategies in high-income countries could possibly be replicated in South Asian countries; however, further community-health promotion studies are necessary to test the effectiveness and scalability of those strategies in the local context.

SUBMITTER: Ghimire K

PROVIDER: S-EPMC8678780 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundSalt intake in China is over twice the maximum recommendation of the World Health Organization. Unlike most developed countries where salt intake is mainly derived from prepackaged foods, around 80% of the salt consumed in China is added during cooking.ObjectiveAction on Salt China (ASC), initiated in 2017, aims to develop, implement, and evaluate a comprehensive and tailored salt reduction program for national scaling-up.MethodsASC consists of six programs working in synergy to increase salt awareness and to reduce the amount of salt used during cooking at home and in restaurants, as well as in processed foods. Since September 2018, two health campaigns on health education and processed foods have respectively started, in parallel with four open-label cluster randomized controlled trials (RCTs) in six provinces across China: (1) app-based intervention study (AIS), in which a mobile app is used to achieve and sustain salt reduction in school children and their families; (2) home cook-based intervention study (HIS), in which family cooks receive support in using less salt; (3) restaurant-based intervention study (RIS) targeting restaurant consumers, cooks, and managers; and (4) comprehensive intervention study (CIS), which is a real-world implementation and evaluation of all available interventions in the three other RCTs. To explore the barriers, facilitators, and effectiveness of delivering a comprehensive salt reduction intervention, these RCTs will last for 1 year (stage 1), followed by nationwide implementation (stage 2). In AIS, HIS, and CIS, the primary outcome of salt reduction will be evaluated by 24-hour urinary sodium excretion in 6030 participants, including 5436 adults and 594 school children around 8-9 years old. In RIS, the salt content of meals will be measured by laboratory food analysis of the 5 best-selling dishes from 192 restaurants. Secondary outcomes will include process evaluation; changes in knowledge, attitude, and practice on salt intake; and economic evaluation.ResultsAll RCTs have been approved by Queen Mary Research Ethics Committee and the Institutional Review Boards of leading institutes in China. The research started in June 2017 and is expected to be completed around March 2021. The baseline investigations of the four RCTs were completed in May 2019.ConclusionsThe ASC project is progressing smoothly. The intervention packages and tailored components will be promoted for salt reduction in China, and could be adopted by other countries.Trial registrationChinese Clinical Trial Registry. AIS: ChiCTR1800017553; https://tinyurl.com/vdr8rpr. HIS: ChiCTR1800016804; https://tinyurl.com/w8c7x3w. RIS: ChiCTR1800019694; https://tinyurl.com/uqkjgfw. CIS: ChiCTR1800018119; https://tinyurl.com/s3ajldw.International registered report identifier (irrid)DERR1-10.2196/15933.

Project description:Understanding major climate risks, adaptation strategies, and factors influencing the choice of those strategies is crucial to reduce farmers' vulnerability. Employing comprehensive data from 2822 farm households in Ethiopia and Kenya (East Africa; EA) and 1902 farm households in Bangladesh, India, and Nepal (South Asia; SA), this study investigates the main climate risks that farmers faced and the adaptation strategies they used. Among others, excessive rainfall and heightened crop pest/disease incidence are commonly observed climate-induced risks in all study areas, while cyclones and salinity are unique to Bangladesh. Drought is prevalent in Ethiopia, India, Kenya, and Nepal. Farmers in those countries responded with strategies that include change in farming practices, sustainable land management, reduce consumption, sell assets, use savings and borrowings, seek alternative employment and assistance from government or NGO. In general, farmers faced several multiple climate risks simultaneously and they responded with multiple adaptation strategies. Therefore, this study used a multivariate probit (MVP) approach to examine the factors influencing the adoption of adaptation strategies. Unlike other studies, we also tested and corrected for possible endogeneity in model estimation. All the countries mentioned have low adaptive capacity to address climate change, which is further weakened by inadequate governance and inefficient institutions. We observed significant differences in the choice of adaptation strategies between male-headed households (MHHs) and female-headed households (FHHs), as well as across countries. Generally, MHHs are more likely to seek additional employment and change agricultural practices, while FHHs and households headed by older persons tend to reduce consumption and rely on savings and borrowings. Institutional support for adaptation is much less in EA compared to SA. Training on alternative farming practices, enhancing non-farm employment options, better institutional support, and social security for older farmers are crucial for climate change adaptation in both regions.

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Salt intake and salt-reduction strategies in South Asia: From evidence to action.

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