South Africa: Paving a new salt road

THE WORK of a University of Wollongong researcher, associate professor Karen Charlton from the university’s School of Health Sciences, has been helpful in putting South Africa at the lead of public health programmes to improve the country’s food supply.

Prof Charlton said that in South Africa, ischaemic heart disease and stroke were the leading causes of death after HIV infection. “Without a doubt, there is excellent, high quality evidence that salt reduction leads to clinically important blood pressure improvements, in both people with and without hypertension. High salt intake increases risk of stroke and cardiovascular disease, as well as gastric cancer in some populations. Importantly, salt intake in childhood contributes to the development of hypertension in later life and a preference for salt taste develops in children as young as two years if they are exposed to high-salt diets,” she said.

In a breakthrough study, people with hypertension from a poor community were given salt-reduced versions of commonly-consumed foods, whilst a control group received the exact same foods prepared in standard fashion. The foods appeared identical, so blinding of research subjects as well as other researchers was possible. After just eight weeks, systolic blood pressure dropped by 6.2 mmHg—which is the magnitude of effect usually only seen with drug therapy.

“We took a very practical approach to our research—firstly, we identified the main contributors to salt intake in the diets of South Africans, and then we worked with the food industry to develop salt-reduced variants of these foods, and lastly, tested them in a community-based randomised controlled trial. It was essential that we were able to demonstrate that the approach was technologically feasible, culturally acceptable, and cost-effective,” Prof Charlton said.

Prof Krisela Steyn, associate director of the Chronic Diseases Initiative in Africa at the University of Cape Town and a member of the research teamwork, said the team was able to convince representatives from the Department of Health that this was an essential approach in South Africa where severely limited health resources were unable to cope with the increasing burden of chronic disease.

Paving the road

In July 11, 2012, South Africa’s Department of Health published draft regulations forthe 1972 South African Foodstuffs, Cosmetics and Disinfectants Act (FCD Act) that aimedto reduce the amount of sodium in processed food. “Our hard work over the past few years to disseminate (our) study findings—not only in the peer-reviewed literature but also through policy briefs and the media—has paid off,” said Prof Steyn.

Meanwhile, Prof Charlton said that in Australia, there have been advances in the salt reduction arena, but progress is slow. With the draft regulations, South Africa is the first country globally to enforce a population-level approach to lower salt and sodium intake, although the announcement also incorporated generous timelines for compliance.

South Africa health minister Aaron
Motsoaledi has made his intent on this issue well known for some time and the move was not a surprise to the food processing industry. Mr Motsoaledi had beforehand declared intentions to set targets to reduce non-communicable diseases radically, including a target to cut down salt intake to less than 5g/ day per person by 2020.

Already in September 2011, Professor Graham Macgregor, chairman of the World Action on Salt and Health (WASH) advocacy group, stated that “South Africa has made a pioneering declaration on NCDs, following on from an NCD summit meeting in Johannesburg September 12Firefly