Reducing population salt intake and saving lives

Developing a toolkit to measure population salt intake and prevent cardiovascular disease

Cardiovascular disease (CVD), the most common cause of death and disability in the world, is responsible for over 11 million deaths yearly and is closely linked with a high dietary salt intake. Professor Francesco Cappuccio and his team at Warwick have developed national and global dietary salt reduction policies that have been adopted across the world, alongside a tool-kit to measure population salt reduction and help implement those policies. In England alone, these policies have already prevented or postponed an estimated 52,000 cases of CVD and 10,000 deaths.

The challenge

Population reduction in salt intake is a World Health Organization (WHO) global priority to reduce cardiovascular disease (CVD), the most common cause of death worldwide. The positive effects of reduced salt intake – reduced risk of strokes and heart attacks – have been well established, but work undertaken by our team has shown how this research can be implemented on an international scale.

Our approach

The ability to monitor and evaluate the effectiveness of intervention policy depends on a valid tool to measure salt intake in populations. The Warwick research team conducted a systematic evidence review that demonstrated a high salt intake significantly increased risk of stroke and CVD, and subsequent research confirmed a lower sodium intake is associated with reduced risk of stroke and fatal coronary heart disease in adults. Warwick research validated the use of 24h urinary sodium excretion tests as the ‘gold standard’ assessment of salt consumption, which has since been adopted as the preferred method in WHO protocols.

This led to the development and implementation of standard protocols to assess population salt consumption that have been adopted internationally. To support their implementation, the team developed a new toolkit ‘Scaling up salt reduction in Europe’, which was launched by the WHO Office for Europe in 2020.

Our impact

The WHO Collaborating Centre for Nutrition at Warwick has influenced the adoption of policies leading to reduced salt intake. Through participating in committees and working groups, writing protocols, guidelines and recommendations, Warwick’s research has benefitted populations, governments, policy makers and health professionals in multiple countries.

The policies developed at Warwick have been adopted by the WHO in Pan American Health Organisation (PAHO), Eastern Mediterranean Regional Office (EMRO) and European WHO region, resulting in the implementation of national salt reduction policies in 5 countries including Greece, Italy, Slovenia, Moldova and Montenegro. Alongside this, the team has contributed to sustainable capacity building to support the implementation of these protocols, setting up Standard Operating Procedures for designing and executing a national population salt intake survey and training 75 health professionals in Slovenia, Moldova and Montenegro. They also contributed to the WHO European Region 2020 Accelerating Salt Reduction In Europe: A Country Support Package To Reduce Population Salt Intake.

As a result of these interventions, between 2013 and 2020, 32,253 CVD events were averted in Moldova and 4,890 in Montenegro through policies recommending a 1g reduction in daily salt consumption. In England, an estimated 52,000 cases of CVD and 10,000 deaths have been prevented. As well as saving lives, these policies are having an impact on national economies; prevented cases of CVD equate to an estimated saving of £15billion for the UK economy. Professor Cappuccio and his team’s research has developed an effective system for identifying and addressing the dangers of high salt consumption on a global scale.

Discover more of Professor Cappuccio's research