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Cited by 1,173Sodium Intake and HealthBlood Pressure and Hypertension StudiesNutritional Studies and Diet

Salt intakes around the world: implications for public health

Brown, I. J, Tzoulaki, I., Candeias, V., Elliott, P.·2009·International Journal of Epidemiology
DOI 10.1093/ije/dyp139
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Abstract

BACKGROUND: High levels of dietary sodium (consumed as common salt, sodium chloride) are associated with raised blood pressure and adverse cardiovascular health. Despite this, public health efforts to reduce sodium consumption remain limited to a few countries. Comprehensive, contemporaneous sodium intake data from around the world are needed to inform national/international public health initiatives to reduce sodium consumption. METHODS: Use of standardized 24-h sodium excretion estimates for adults from the international INTERSALT (1985-87) and INTERMAP (1996-99) studies, and recent dietary and urinary sodium data from observational or interventional studies--identified by a comprehensive search of peer-reviewed and 'grey' literature--presented separately for adults and children. Review of methods for the estimation of sodium intake/excretion. Main food sources of sodium are presented for several Asian, European and Northern American countries, including previously unpublished INTERMAP data. RESULTS: Sodium intakes around the world are well in excess of physiological need (i.e. 10-20 mmol/day). Most adult populations have mean sodium intakes >100 mmol/day, and for many (particularly the Asian countries) mean intakes are >200 mmol/day. Possible exceptions include estimates from Cameroon, Ghana, Samoa, Spain, Taiwan, Tanzania, Uganda and Venezuela, though methodologies were sub-optimal and samples were not nationally representative. Sodium intakes were commonly >100 mmol/day in children over 5 years old, and increased with age. In European and Northern American countries, sodium intake is dominated by sodium added in manufactured foods ( approximately 75% of intake). Cereals and baked goods were the single largest contributor to dietary sodium intake in UK and US adults. In Japan and China, salt added at home (in cooking and at the table) and soy sauce were the largest sources. CONCLUSIONS: Unfavourably high sodium intakes remain prevalent around the world. Sources of dietary sodium vary largely worldwide. If policies for salt reduction at the population level are to be effective, policy development and implementation needs to target the main source of dietary sodium in the various populations.

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  • Most sodium in Asian countries comes from soy sauce or is added at home.

    “In Asian countries, most sodium is from soy sauce or is added at home.158”

    From Components of a Cardioprotective Diet: New Insights (2011) · cites this paper as [158]

  • Packaged, preprepared, or restaurant foods supply 75% of sodium intake in North America and Europe.

    “In North America and Europe, 75% of sodium intake is derived from packaged, preprepared, or restaurant foods, with the rest being naturally occurring or added at home.158”

    From Components of a Cardioprotective Diet: New Insights (2011) · cites this paper as [158]

  • In North America and Europe, most sodium (~75%) comes from packaged foods and restaurants, and little from home cooking or table salt; while in Asian countries, most sodium comes from soy sauce and salt added during cooking or at the table.

    “In North America and Europe, most sodium (~75%) comes from packaged foods and restaurants, and little from home cooking or table salt; while in Asian countries, most sodium comes from soy sauce and salt added during cooking or at the table.302”

    From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [302]

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Authors
Brown, I. J., Tzoulaki, I., Candeias, V., & Elliott, P.
Affiliations
  • Imperial College London (GB)
  • World Health Organization (CH)
Corresponding author
Elliott, P.
ORCID
Venue
International Journal of Epidemiology
Publisher
Oxford University Press (OUP)
Published
2009-04-07
Volume
38
Issue
3
Pages
791-813
ISSN
  • 0300-5771 (ISSN-L)
  • 1464-3685
DOI
10.1093/ije/dyp139
OpenAlex
W2154301407
Cited by
1,173
References
157
Citations by year
2026: 13 · 2025: 31 · 2024: 33 · 2023: 61 · 2022: 66 · 2021: 87 · 2020: 94 · 2019: 81 · 2018: 78 · 2017: 90 · 2016: 98 · 2015: 109 · 2014: 95 · 2013: 92 · 2012: 61
FWCI
46.14
Type
journal article
Language
en
Open access
closed
Locations
  • International Journal of Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
World Health Organization
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords
sodium intake, salt reduction, sodium excretion, INTERSALT, INTERMAP, sodium sources, processed foods, soy sauce, blood pressure, cardiovascular health, salt reduction policy, cross-national comparison
MeSH terms
Adolescent, Adult, Cardiovascular Diseases, Child, Child, Preschool, Cooking, Cross-Cultural Comparison, Diet, Feeding Behavior, Female, Health Promotion, Humans, Hypertension, Infant, Infant, Newborn, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Global Health, Sodium Chloride, Dietary, Young Adult

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