Barts and The London School of Medicine and Dentistry

Salt and Sugar in Our Diets

Summary

Research at Barts and the London School of Medicine and Dentistry led by Prof. MacGregor and his team has been instrumental in convincing the government to implement a structured salt reduction programme. As a result, average intakes in salt across the UK have fallen from 8.5g/day in 2011 to 8.0 g/day in 2014. More than 75 countries worldwide have a programme of salt reduction, largely copying the UK model of salt reduction. More than 40 have set salt reduction targets, of which 9 are regulated. This will save many thousands of people dying and suffering from unnecessary strokes and heart attacks. 

Action on Sugar set up by Prof. MacGregor’s team in 2014 has successfully campaigned the government to set up a childhood obesity plan and a sugar reduction programme. It has also pressured food and drink manufacturers for example cereal and energy drink manufacturers to reformulate their products to include less sugar.

The science: how much salt and sugar do we need?

Cardiovascular diseases are the number one cause of death worldwide, for which high blood pressure is a major risk factor. Chronic excess salt consumption is likely responsible for approximately half of the disease burden caused by high blood pressure. Humans only need a small amount of salt from the diet (less than 1g per day) to maintain normal physiological function, however the vast majority of the global population, including children, eat far more than they need (UK average daily salt intake is 8.1g/d). Prof. Macgregor’s team showed that a longer-term modest reduction in salt intake, as recommended, resulted in a significant reduction in blood pressure. This reduction was predicted to reduce stroke mortality by 14% and coronary mortality by 9% in individuals with high blood pressure, and reduce stroke and coronary mortality by 6% and 4%, in individuals with normal blood pressure. 

Research from Prof. MacGregor’s group led to the creation of the charity CASH, which worked in collaboration with the Food Standard Agency (FSA) to develop a voluntary policy of salt reduction in the UK. They found that the reduction in salt intakes (9.5-8.1g/day from 2003-2011) led to a fall in population blood contributing to the decreased incidence in stroke and heart disease mortality [3.3].

An international arm of CASH was set up in 2005 titled World Action on Salt and Health (WASH). WASH is now a global network of more than 500 experts in over 100 countries. WASH aims to reduce population salt intake worldwide by working with experts to initiate salt reduction programmes.

Action on Sugar has published four surveys investigating the amount of sugar present in different food and drink products including cakes, biscuits and chocolate products.

Putting research into action: impact on national and global public health and the food and drink industry

WASH members in each country are encouraged to set up their own country’s division of WASH to work together on a local level to lower salt intake specifically in their own population. A notable example is Portuguese Action Against Salt and Hypertension (PAASH), a 2015 campaign set up by WASH members working with the Portuguese Society of Hypertension, with expert input from prof. MacGregor. They carried out a study involving almost 500 people, which demonstrated that the average salt intake was 11.9 g/day - twice the recommended level for adults

Through WASH, prof. MacGregor and his team worked with the Ministry of Health, South Africa, to develop salt targets for food products that contribute the most salt to the South African diet. Following this work, the salt reduction targets which were signed into law by the Minster of Health will be implemented from 2016, making South Africa the first country to make salt reduction mandatory in the food industry

Action on Sugar has informed the content of the government’s childhood obesity plan and a sugar reduction programme led by Public Health England (PHE). Action on Sugar’s modelling study has played a key role in ensuring that the UK implemented the SDIL whereby manufacturers have to reformulate their drinks to avoid the levy. Action on Sugar published a briefing paper jointly with the Food Research Collaboration in 2016 investigating the latest available evidence on the consumption of energy drinks on health in children and teenagers in order to make policy recommendations, such as clearer labelling, marketing restrictions, legislation to ban the sale of energy drinks to children, in-school interventions and local authority policies.

Following the surveys on the sugar content of breakfast cereals sugar reduction commitments have been announced by many leading cereal brands and retailers, including Kellogg’s, Waitrose and Nestle. Leading drinks brands and retailers have already committed to reducing sugar in their drinks such as Lucozade, Ribena and Tesco.