How much salt do you consume daily? WHO advises 5 g per day to lower blood pressure, risk of heart disease

Hyderabad: The World Health Organisation (WHO) has recently suggested reducing daily sodium intake to 2 g per day (or 5 g of salt) for adults to reduce blood pressure, stroke, coronary heart disease and risk of cardiovascular diseases.

While WHO has recommended a salt intake of 5 g per day per person (equivalent to 2 g of sodium), the average consumption is almost double in India at 9.8 g per person per day.

The recommendation has been published in the WHO guideline on ‘Use of lower sodium salt substitutes (LSSS).’ WHO’s ‘strong recommendation’ can be adjusted for children depending on their energy requirements.

The guideline also suggested replacing sodium chloride (NaCl), a common source of sodium, with potassium chloride (KCl) to meet the sodium demands.

Recommendation exempts pregnant women, children

Table salt is the most common source of sodium intake, and its reduced usage has also been suggested for reducing the intake of sodium.

Dr Kiran Madhala, secretary general of Telangana Teaching Government Doctors Association (TTGDA) said, “The recommendation for a reduced sodium intake is applicable to adults but not for pregnant women and children. Those who still want to use table salt can continue to do so with lower sodium salt substitutes which contain potassium. Those with kidney ailments are also exempted from this suggestion.”

LSSS is gaining attention but shortage of guidance

LSSS are gaining attention from national health authorities and public health organisations. These substitutes are being increasingly viewed as an important strategy to reduce sodium intake, which could help lower blood pressure and cardiovascular disease risk.

In the absence of any specific guideline, the increased use of potassium can also lead to high levels of blood potassium (hyperkalaemia) which could prove to be harmful for those with kidney ailments, and hence an important review of the existing guidance becomes important to formulate a global guidance.

Hypothesis behind recommendation

The recommendation has considered the effects and safety of LSSS compared to regular salt.

The prioritised outcomes are the effects on blood pressure, serum potassium (hyperkalaemia, hypokalaemia), stroke and cardiovascular events and mortality.

Further, 26 randomised trials on LSSS also revealed reduced systolic blood pressure (SBP) and diastolic blood pressure (DBP) over 56 days to five years of follow-up after the trials. The effect of sodium excretion for 24 hours of LSSS compared to regular salt also showed heterogeneity.

Key to preventing NCD

Poor diet plays a role in casualties across the globe, with 8 million deaths being associated with it. Around 1.9 million deaths are attributed to high sodium intake and hence its reduction becomes important in preventing non-communicable diseases (NCD).

The Global Action Plan for the Prevention and Control of NCDs was endorsed by WHO in 2013 and was expected to be completed by 2020 but has been extended to 2030. As per the plan, the member states assured to reduce mean population sodium intake by 30 per cent which contributed to meeting the overall goal of 25 per cent reduction in premature mortality from NCDs.