High levels of dietary sodium intake are associated with raised blood pressure and cardiovascular disease. Furthermore, a high salt diet may have direct harmful effects independent of its effect on blood pressure, for example, by increasing the risk of stroke, increasing heart size and renal disease. Increasing evidence also suggests that salt intake is related to obesity, associated with renal stones and osteoporosis and is probably major cause of stomach cancer.

Various studies have shown that salt intake around the world is well in excess of physiological need, both in children and adults. In a recent study, it has been found that in European and Northern American countries, sodium intake is dominated by sodium added in manufactured foods (75% of intake). Cereals and baked goods were the single largest contributor to dietary sodium intake in UK and US adults. On the other hand, in Japan and China, salt added at home (in cooking and at the table) and soy sauce were the largest sources.

The World Health Organisation recommends an intake of no more than a total of 5 grams of salt per day. Unfortunately the current daily salt consumption in most European countries is estimated or measured to range between 8-12 grams per day, with few member states above and few below this intake level.

In Malta there is very limited data. In fact the current salt intake in Malta is not known. However, the 1986 Intersalt Study found that Maltese men consumed 11g per day and women consumed 9g per day. The 2002 Health Interview Survey conducted in Malta, showed that 47% of the participants added salt to their meals while cooking, whereas 23% added salt upon eating.

In the Health Interview Survey of 2008, 22% of the population aged above 18 years self-reported hypertension. However the burden is much higher, especially in patients above 40s. In fact, the 2010 European Health Examination Survey reports that 46% of patients aged 41-60 years were classified as having possible hypertension while 85.5% of patients aged 60 years have been classified as possibly hypertensive.

This year, the Health Promotion and Disease Prevention Directorate will be starting a National Food Consumption Survey, which will give a good picture of the food and beverage consumption patterns locally including that of salt.

The impact of increased salt consumption has been defined as a critical issue by the WHO and by the European Commission. All member states are encouraged to tackle this issue immediately as the current salt consumption patterns are leading to 80% of all deaths. Reducing salt intake can make a difference. It was found that reducing salt by 5g a day will result in a 23% decrease in stroke cases and 17% decrease in cardiovascular disease cases. A small reduction in blood pressure of 1-4 mmHg showed a reduction of cardiovascular deaths by 5 -20%.

Malta has joined the EU initiative to reduce salt in order to reduce the burden of illness. Various initiatives have already been launched, targeting the general public to increase awareness on the effects of salt on health, to read labels and to enhance skills in using alternative products in cooking. Work has also been initiated with industry to encourage the reduction of salt.

Many people think that their salt consumption levels are low but one can be really surprised to know about food which has a high salt content. Salt is naturally present at low levels in all foods but around 80% of our salt intake is hidden in processed food. Most of the salt is in everyday foods such as bread, cheese and sauces, so most of us are eating too much salt without even knowing.

Some foods that are high in salt don’t taste particularly salty. Breakfast cereals, bread, jarred sauces and biscuits & cakes can all contain hidden salt. Some people think that food with less salt will taste bland; however it is good to know that within 3-4 weeks the taste buds will adjust and become more sensitive so you will get the same amount of flavour from less salt and will even prefer the taste of food with less salt. You’ll also be able to taste the natural flavours of food. Apart from this, one can use other flavours such as herbs to flavour food.

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Dr Charmaine Gauci