Salt reduction in China: a state-of-the-art review
Authors Shao S, Hua Y, Yang Y, Liu X, Fan J, Zhang A, Xiang J, Li M, Yan LL
Received 29 September 2016
Accepted for publication 7 December 2016
Published 22 February 2017 Volume 2017:10 Pages 17—28
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Professor Frank Papatheofanis
Shuai Shao,1,2 Yechu Hua,3 Ying Yang,4 Xiaojuan Liu,5 Jingruo Fan,6 An Zhang,7 Jingling Xiang,8 Mingjing Li,9 Lijing L Yan1,2
1Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China; 2Duke Global Health Institute, 3School of Economics, Duke University, Durham, NC, USA; 4Department of Public Health, Wuhan University, Wuhan, Hubei, 5Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China; 6Department of Accounting, School of Business and Management, The Hong Kong University of Science and Technology, Kowloon, Hong Kong; 7Department of Statistics and Applied Probability, National University of Singapore, Singapore; 8School of Business, Sichuan University, Chengdu, Sichuan, 9Department of Public Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
Objective: This study aimed to reveal the latest evidence on salt reduction initiatives in China in order to identify the contextual cost-effective interventions, as well as the barriers encountered during China’s long march to reach its population salt reduction goal.
Background: Population-based salt reduction has been considered as one of the most cost-effective strategies in the world for the prevention and control of noncommunicable diseases. China, along with its sustained economic growth, faces increasing burdens from chronic diseases such as cardiovascular and kidney diseases. With policy support and cross-sector collaboration, various salt reduction initiatives have been adopted in China in order to reduce such dietary risk, especially since the beginning of this millennium.
Methods: This study conducted structured literature reviews in both English and Chinese databases and synthesized the latest evidence on the association of salt intake and health, as well as salt intake among Chinese and population-based salt reduction strategies in China and around the world.
Findings: Dietary salt restriction has been found to contribute to the reduction of blood pressure among both the normotensives and hypertensives bringing associated reduced disease burdens and great public health benefits. With gender, ethnic, and regional variations, salt intake levels in the population in China are well above the recommended threshold and physiological need. Admittedly, excessive salt intake precipitates the high prevalence of hypertension and cardiovascular disease among the Chinese. Considering that the majority of the dietary salt is added during cooking in China, salt substitutes, salt restriction tools, and health education are the most common salt reduction initiatives with varying levels of effectiveness and acceptability among the Chinese population.
Implication: Overwhelming evidence is in support of a well-coordinated nationwide salt restriction initiative as a key public health strategy for the prevention and control of hypertension and its related diseases. Orchestrated efforts from the government, industries, academia, health professionals, and the general public are required to achieve China’s long-term goal for salt reduction.
Keywords: chronic disease, hypertension, salt reduction, health policy, Chinese population
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