A World Health Organization adviser is calling for the government to stop food manufacturers and distributors producing and selling unhealthy, cheap, salty junk food.
Francesco Cappuccio, Professor of Cardiovascular Medicine and Epidemiology at Warwick Medical School, is making the appeal after conducting 30 years of research into the diets of populations around the world.
His latest study has been published in BMJ Open. It indicates that across Europe people of low socio-economic background eat more salt than those on higher incomes – which can contribute to the lower life expectancy seen in these groups.
Professor Cappuccio said: “The 2010 Marmot Review in the UK and work conducted by the World Health Organization reveal that people from poorer backgrounds not only die sooner but spend more of their lives with disabilities. Inequalities in nutritional and socio-economic status translate ultimately into inequalities in health.
“The government can do something about this by discouraging manufacturers from producing cheap, salty food and distributors from selling them. These are the types of foods consumed by those on lower incomes because they are inexpensive but ultimately they have a detrimental effect on your health.”
The study, the Geographic and socio-economic variation of sodium and potassium intake in Italy, also unearthed a significant north–south divide. Participants living in less affluent southern Italy (e.g. Calabria, Basilicata and Puglia) had significantly higher salt intake than elsewhere. In a previous study Prof. Cappuccio found similar results across Britain where salt intake is higher further north in Scotland compared to more affluent, southern parts of the British Isles. He believes that his latest study demonstrates that social inequalities in salt intake are a Europe-wide problem.
Despite Italy being renowned for its healthy Mediterranean diet the latest research suggests that people in the poorer areas of the country, mostly in the south, have more salt in their diets than those in the more affluent north, even taking into account factors such as differences in regional cuisine and salt from sources other than diet.
The research examined 3,857 men and women aged between 39-79 years. They were chosen randomly across 20 Italian regions as part of a bigger national cardiovascular survey. The research team measured the amount of sodium in the urine of participants, an indication of salt consumption. They found that across Italy there was an association between salt intake and income and educational attainment. Those in lower skilled jobs had 6.5% more sodium in their urine (high salt consumption) compared to those in top managerial jobs. There was a similar relationship between education as those who were educated to just junior school level ate 5.9% more salt that those with university degrees.
National guidelines advise that adults should eat no more than 6g of salt a day which is approximately equivalent to one teaspoon and children should eat less. Previous studies show that a 5g per day higher salt intake is associated with a 24% higher risk of stroke.
Professor Cappuccio said: “Dietary salt, primarily sodium chloride, is commonly used for food preservation and seasoning. In most westernised countries, like the UK, approximately 75% of salt consumed is hidden in processed and restaurant foods whereas only about 15% comes from discretionary use such as added at the table or in cooking by the consumer or food handler and 10% from natural sources.
During the past 15 years the British government conducted one of the most successful salt reduction campaigns in the world with an average reduction of salt consumption of 1.5g a day over eight years. However in research published last year Professor Cappuccio demonstrated that there is still social inequality.
He said: “Since 2010-11, with the introduction of the Responsibility Deal – a sharp policy change making food industries responsible for improving nutrition - the sustained action previously exerted on manufacturers to reformulate their food with less salt has slowed down. This setback will undoubtedly lead to wider health inequalities with worse consequences seen in those groups of society who most of all need effective prevention. We now have convincing evidence in Britain and across Europe that more regulatory actions and mandatory enforcements are needed to deliver a reduced-salt environment for all to benefit from.”
Professor Cappuccio leads research in cardiovascular health at Warwick Medical School, University of Warwick. The group’s main interests are the prevention, detection and management of hypertension and its complications, and the epidemiology of cardiovascular disease. The relationships between nutrition, metabolic abnormalities and cardiovascular risk, including risk assessment in ethnic minorities, both in developed and developing countries, are also being studied. Professor Cappuccio is also a Technical Expert on salt for the National Institute of Care and Excellence and the World Health Organization.
Notes to Editors
Paper: Cappuccio FP, Ji C, Donfrancesco C, Palmieri L, Ippolito R, Vanuzzo D, Giampaoli S, Strazzullo P. Geographic and socio-economic variation of sodium and potassium intake in Italy. Results from the MINISAL-GIRCSI programme. BMJ Open 2015: 5: e007467 doi: 10.1136/BMJOPEN-2014-007467.
The analysis was led by Prof FP Cappuccio, University of Warwick, WHO Collaborating Centre for Nutrition, Warwick Medical School, Division of Mental Health and Wellbeing. Collaborators were:
- C. Ji, University of Warwick, Warwick Medical School
- C. Donfrancesco, L. Palmieri and S. Giampaoli from Istituto Superiore di Sanita' Rome
- R. Ippolito and P. Strazzullo from Federico II University of Naples
- D. Vanuzzo, from the National Association of Hospital Cardiologists, Florence
The study was funded by the Italian Ministry of Health and the Bupa Foundation.
Prior research conducted by Prof Cappuccio:
- Cappuccio FP, Capewell S. Facts, issues and controversies in salt reduction for the prevention of cardiovascular disease. Functional Food Reviews 2015; 7(1): 41-61
- Ji C, Kandala N-B and Cappuccio FP. Spatial variation of salt intake in Britain and association with socio-economic status. BMJ Open 2013; 3: e002246
- Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl J. Effect of lower sodium intake on health outcomes: systematic review and meta-analysis. Br Med J 2013; 346: f1326
- Rodriguez-Fernandez R, Siopa M, Simpson SJ, Amiya RM, Breda J & Cappuccio FP. Current salt reduction policies across gradients of inequality-adjusted human development in the WHO European region: minding the gaps. Public Health Nutrition 2014; 17 (8): 1894-904
- Ji C and Cappuccio FP. Socio-economic inequality in salt intake in Britain 10 years after a national salt reduction programme. BMJ Open 2014; 4: e005683
- Cappuccio FP, Capewell S, Lincoln P, McPherson K. Policy options to reduce population salt intake. Br Med J 2011; 343: 402-5
- Strazzullo P, D’Elia L, Kandala N-B, Cappuccio FP. Salt intake, stroke and cardiovascular disease: a meta-analysis of prospective studies. Br Med J 2009; 339: b4567
- Cappuccio FP. Salt and cardiovascular disease. Br Med J 2007; 334: 859-60
University of Warwick
M: 07824 540863E: N.Jones.email@example.com