Article Text
Abstract
Introduction High dietary sodium is a leading contributor to hypertension, and hypertension is the leading underlying cause of death globally. There is a robust body of evidence supporting the health benefits of sodium reduction. Sodium intake in South Korea is high, with about half the population consuming >4000 mg/day, twice the recommended upper limit.
Methods In 2012, South Korea implemented its National Plan to Reduce Sodium Intake, with a goal of reducing population sodium consumption by 20%, to 3900 mg/day, by 2020. The plan included five key components: (1) a consumer awareness campaign designed to change food consumption behaviours; (2) increased availability of low-sodium foods at schools and worksites; (3) increased availability of low-sodium meals in restaurants; (4) voluntary reformulation of processed foods to lower sodium content; and (5) development of low-sodium recipes for food prepared at home. Monitoring and evaluation included tracking sodium intake and sources of dietary sodium using the Korea National Health and Nutrition Examination Survey.
Results By 2014, South Korea had reduced dietary sodium consumption among adults by 23.7% compared to a survey conducted in 2010 prior to implementation of a nationwide salt reduction campaign that used this comprehensive, multipronged approach. The reductions in sodium intake were accompanied by reductions in population blood pressure and hypertension prevalence. Although causal associations between the sodium reduction programme and reduced sodium intake cannot be made, the declines occurred with the introduction of the programme.
Conclusion Multicomponent interventions have great potential to reduce population sodium intake. Lessons learnt from South Korea could be applied to other countries and are likely very relevant to other Asian countries with similar food sources and consumption profiles.
- cardiovascular disease
- hypertension
- nutritional and metabolic disorders
- health education and promotion
- health policy
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Footnotes
Handling editor Sanne Peters
Contributors Each of the listed authors meets the criteria for 'Authorship' in accordance with the ICMJE recommendations as outlined below. Substantial contributions to the conception or design of the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding This analysis was conducted with support from Resolve to Save Lives, an initiative of Vital Strategies. Resolve to Save Lives is funded by grants from Bloomberg Philanthropies; the Bill and Melinda Gates Foundation; and Gates Philanthropy Partners, which is funded with support from the Chan Zuckerberg Foundation.
Competing interests NRCC is a member of World Action on Salt and Health (WASH).
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting or dissemination plans of this research. Refer to the 'Methods' and 'Patient and public involvement' sections for further details.
Patient consent for publication Not required.
Ethics approval Before 2015, KNHANES had been conducted under IRB approval in the KCDC (IRB 2012-01EXP-01–2C, 2013-07CON-03–4C and 2013-12EXP-03–5C).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data used for analysis are available in public, open access repositories: https://knhanes.cdc.go.kr/knhanes/sub04/sub04_03.do for yearly health statistics by KCDC; http://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1B34E01&conn_path=I2&language=en for death rates by cause by Statistics Korea; and https://www.khidi.or.kr/board/view?pageNum=1&rowCnt=10&no1=749&linkId=48825415&menuId=MENU00085&maxIndex=00488254159998&minIndex=00002101249998&schType=0&schText=&schStartDate=&schEndDate=&boardStyle=&categoryId=&continent=&country= for dietary sources of sodium.