Guest post by Ruth Situma, Nutrition Specialist - Micronutrients, UNICEF
Salt and its role in nutrition are controversial topics. There are passionate views and valid research-based insights about salt consumption, which have governments, global health authorities and food companies confronted with the dilemma of finding a place for salt in a healthy diet, while managing its overconsumption.
Salt is widely consumed globally. Approximately 90% of the salt consumed in industrialized countries is from processed foods, while developing countries largely consume salt in home-cooked food. The latter trend is gradually changing with increased urbanization. Salt is unique as it is one of the foodstuffs that is consistently consumed all year round. Because of its universal appeal, the iodization of salt has been an important nutrition intervention, and has helped reduce iodine deficiency rates globally.
According to the WHO approximately 70% of the global population has access to adequately iodized salt. The WHO states that “salt is generally used as the vehicle for providing iodine because it is consumed by most of the population at fairly constant levels throughout the year, and its taste and appearance is not affected by iodization.”
The impact of salt iodization programs is well documented. According to the WHO, iodine deficiency is the world's most prevalent, yet easily preventable, cause of brain damage. With the help of salt iodization, the number of countries classified as iodine deficient has declined from 54 to 32 in the past 10 years, but there are some regions where rates remain elevated (South East Asia and Africa) or are on the rise (United Kingdom, Australia and the Republic of Ireland).
While salt has been an important conduit for a critical micronutrient, its increasing overconsumption contributes to escalating rates of hypertension and cardiovascular diseases. In 2007, the WHO came out with their salt consumption recommendations of <5 grams per day per person in an effort to prevent chronic diseases. This target may seem overambitious to some given salt’s prevalence in processed, packaged and snack foods, but with enabling policies and programs, and consumer engagement with salt consumption reduction efforts, global health authorities believe that we can make progress toward this target.
The challenge with salt is that it is lauded for its role in reducing rates of iodine deficiency diseases, but at the same time villainized for contributing to growing health problems. What does this mean for iodization efforts and calls for universal salt iodization programs? Do we throw out the baby with the bath water? Do we look to other mechanisms by which to ensure adequate iodine intake? Were we sending the wrong message when we added an important micronutrient to a food that must be consumed in moderation?
All these questions are valid and worth debating. As far as iodization efforts are concerned, a recent report written by health, nutrition and food fortification experts recognizes salt’s important role in the diet. Moderation is key and in that moderation, we can actually increase fortification levels of iodine to reflect the new WHO recommendations for salt intake. This is important news for universal iodization advocacy efforts.
The fact is that we can and should promote reduced intake of salt, while not compromising the positive nutritional and health impact we have experienced with salt iodization efforts. We must push forward with advocating for the universal access and use of iodized salt and know that we are not sending a mixed message. It’s ultimately about good communications to the public, enabling government policies, improved production and distribution efforts, and adjusted fortification levels to give consumers the maximum fortification benefit packed in a smaller punch.
Ruth Situma is a Nutrition Specialist; Micronutrients in UNICEF HQ New York. She has vast experience in Nutrition and Food security programmes in different countries in areas including Nutrition in emergencies, Micronutrients programmes, Nutrition information systems, Nutrition policies and advocacy.