Division of Non-communicable Diseases, Indian Council of Medical Research, New Delhi, India.
Resolve to Save Lives, All India Institute of Medical Sciences, New Delhi, India.
Indian J Med Res. 2023 Sep;158(3):233-243. doi: 10.4103/ijmr.ijmr_1059_23.
Salt plays a critical role in India's past as well as its present, from Dandi March to its role as a vehicle for micronutrient fortification. However, excess salt intake is a risk factor for high blood pressure and cardiovascular diseases (CVDs). Indians consume double the World Health Organization recommended daily salt (<5 g). India has committed to a 30 per cent reduction in sodium intake by 2025. Evidence based strategies for population sodium intake reduction require a moderate reduction in salt in - home cooked foods, packaged foods and outside-home foods. Reducing the sodium content in packaged food includes policy driven interventions such as front-of-package warning labels, food reformulation, marketing restrictions and taxation on high sodium foods. For foods outside of the home, setting standards for foods purchased and served by schemes like mid-day meals can have a moderate impact. For home cooked foods (the major source of sodium), strategies include advocacy for reducing salt intake. In addition to mass media campaigns for awareness generation, substituting regular salt with low sodium salt (LSS) has the potential to reduce salt intake even in the absence of a major shift in consumer behaviour. LSS substitution effectively lowers blood pressure and thus reduces the risk of CVDs. Further research is required on the effect of LSS substitutes on patients with chronic kidney disease. India needs an integrated approach to sodium reduction that uses evidence based strategies and can be implemented sustainably at scale. This will be possible only through scientific research, governmental leadership and a responsive evidence-to-action approach through a multi-stakeholder coalition.
盐在印度的过去和现在都起着至关重要的作用，从食盐进军到作为微量营养素强化的载体。然而，摄入过多的盐是导致高血压和心血管疾病（CVD）的一个风险因素。印度人摄入的盐是世界卫生组织建议的每日摄入量（<5 克）的两倍。印度已承诺到 2025 年将钠摄入量减少 30%。基于证据的人群钠摄入量减少策略需要在家常烹饪食品、包装食品和外出就餐食品中适度减少盐的使用。降低包装食品中的钠含量包括政策驱动的干预措施，如包装正面的警告标签、食品配方调整、营销限制和对高钠食品征税。对于外出就餐的食品，设定像学校供餐计划这样购买和供应的食品标准可以产生适度的影响。对于家常烹饪食品（钠的主要来源），策略包括倡导减少盐的摄入。除了开展大众媒体宣传活动以提高意识外，用低钠盐（LSS）替代普通盐还有可能在消费者行为没有重大转变的情况下减少盐的摄入。LSS 替代可以有效地降低血压，从而降低 CVD 风险。还需要进一步研究 LSS 替代品对慢性肾脏病患者的影响。印度需要采取综合的减钠方法，使用基于证据的策略，并能在大规模范围内可持续地实施。这只有通过科学研究、政府领导和通过多利益相关者联盟采取响应式循证行动方法才能实现。
