The Role of Salt in UK Diet - Essay Example

The Role of Salt in the Diet in the United Kingdom Table of Contents Introduction 5 2. Salt and its Role in Health 5 3. Salt Consumption Nutritional Advice in the United Kingdom : 8 4. Perceptions of Public in the United Kingdom on Dietary Role of Salt : 9 5. Consumption of Salt in the United Kingdom : 10 6. Sources of Dietary Salt in the United Kingdom : 12 7. Initiatives to Curb the Daily Consumption of Salt in the United Kingdom : 14 8. Conclusion : 15 Acknowledgements Guidance and assistance in the execution of this paper has been sought and received from my tutors and professors. I wish to acknowledge this support received from them and offer my thanks. Abstract Sodium is essential to the human body as it plays a role in the normal human physiology. Sodium is present in salt and the daily requirement of sodium is met by the salt that forms a part of our diet. The physiological requirements of the body require a daily dietary intake of 4.2g of salt. Consumption of salt in excess of the daily physiological requirements is detrimental to health, as it is an environmental factor that poses a risk for the development high blood pressure, with its ensuing consequences. The WHO has recommended that the daily intake of salt should not exceed 6g, which is the norm flowed by the nutrition and health advisory bodies in the United Kingdom. The people in the United Kingdom have a limited knowledge of the role of salt in the diet, the health risks posed by excess salt consumption and the recommendations on the daily consumption of salt. Though there are variances in the consumption of salt among the different regions in the United Kingdom, the consumption of salt in the United Kingdom exceeds the prescribed norm of 6g per day. The main contribution to the excess salt consumption in the United Kingdom comes from manufactured food products and not from food prepared at home or salt added as flavouring at the table. The Foods Standards Agency (FSA) has set in motion a voluntary target for the reduction of the percentage of salt in 85 manufactured food products in a move to curb the consumption of salt in the United Kingdom 1. Introduction: Salt or sodium chloride is essential for maintaining good health and needs to be a part of our daily diet. Salt is an ingredient in many of the food preparations made at home and in the manufactured food products that we purchase. The daily intake of salt is based on the quantity of salt present in home cooked food and in manufactured food products that are consumed. However, salt consumed in excess of our daily requirements is responsible for a number of diseases and conditions in our body like high blood pressure that constitute bad health. The effects of excess intake of salt are gradual and quite often are demonstrated as we advance in age. Present food habits are such that the daily consumption of salt in the United Kingdom is far in excess of the daily requirements, which has made the consumption of salt through the daily diet a public health matter of concern. 2. Salt and its Role in Health: The chemical name for salt or common salt is sodium chloride. As the name suggests it contains sodium. Salt is an essential part of daily diet, as sodium has a role to play in the normal functioning of the body. The essential function of sodium in the human body is the keeping of bodily fluid within close and regulated limits (Gibson, Armstrong & McIlveen, 2000). Sodium constitutes forty percent of salt by weight. The sodium present in salt is necessary for maintaining extra-cellular fluid and through this its influence on the blood pressure levels of an individual. It is also required for the transmission of electrical impulses within the nerves and muscles and for absorption of some nutrients in the small intestine. These physiological requirements place a demand on the daily intake of salt and the Reference Nutrient Intake of sodium is 1.6g per day, which makes for a daily intake of 4.2g of salt (British Nutrition Foundation, 1994). The content of sodium in the body is regulated by excretion through the kidneys (Gibson, Armstrong & McIlveen, 2000). Salt is essential to the maintenance of good health, but needs to be consumed within the daily dietary requirements, for excess consumption is likely to have a negative impact on health. There remains some controversy on the issue of the excess salt consumption and its impact on the health of an individual. This controversy has arisen because of the contrary results that have emerged from the main studies that have evaluated the impact of excess salt on the health of an individual. These contrary results show negative impact as well as no impact, leading to the position that only some individuals are sensitive to the excess intake of salt and these are those individuals with heart, liver and kidney problems by some of the scientific community, while a larger part of the scientific community take the stand that excess consumption of salt has a negative impact on health (Ellis, 2006). This perception is reflected in the words of Nerys, 2005, p.33, “salt is well recognised as a cause of high blood pressure, but it has also been linked to stomach cancer”. The International Conference on Salt and Health, Ministry of Health, Paris, France, 11 January 2002, puts this issue in the right perspective. The regulation of blood pressure is complex in that it is controlled through several mechanisms that involve several genetic factors and environmental factors working in conjunction with factors of age and sex. Based on estimates it can be safely said that thirty percent of elevation in blood pressure levels is due to genetic factors, while eighty percent of this elevation is due to environmental factors. Salt is an important environmental factor in this scheme of things and influences blood pressure not only in populations, but also in families where there is a familial resemblance to acute and chronic salt challenges (British Nutrition Foundation, 2002). This perspective gives two added dimensions to the negative impact of consumption in salt in excess of daily nutritional requirements and these are the factors of sex and age. Men are more prone to the negative impact of excess salt consumption, because males over the age of forty-five tend to consume salt in excess of the daily nutritional requirements and are less inclined to change this dietary practice (Mutel, 2004). The second dimension is the factor of age. In the United Kingdom life expectancy has been increasing leading to growing numbers in the ageing population in country. Though life expectancy has increased it is not coupled with healthy life expectancy. This is because the consequences of unhealthy life styles start to demonstrate more emphatically with aging, as a result of the accumulation of the molecular cell damages built up over time. Diet is a key factor in the development of chronic diseases, like blood pressure that are associated with ageing (Denny, 2008). In the United Kingdom cardiovascular diseases are a major cause of ill health and disability. There is general agreement in poor dietary habits along with poor life styles being major contributory factors for cardiovascular diseases. Among the dietary components of poor dietary habits as a contributory factor for cardiovascular diseases is consumption of salt in excess of the daily nutritional requirement (Kelly & Stanner, 2003). The seriousness of the issue of cardiovascular diseases and its impact on the public health can be seen from the figures related to cardiovascular diseases in the United Kingdom. In the United Kingdom it is estimated that around eighteen million people suffer from elevated blood pressure levels, which is also termed hypertension. The probability of individuals developing heart disease or having a stroke event is three times higher in individuals with elevated blood pressure, than in individuals with normal blood pressure. In the United Kingdom the mortality rate every year, as a result of stoke is about 50,000, while around 238,000 people die every year from heart disease. This highlights the role of ensuring that the intake of salt is in keeping with dietary requirements (Ellis, 2006). 3. Salt Consumption Nutritional Advice in the United Kingdom: The World Health Organization (WHO) Technical Report has proposed a standard for the daily dietary intake of salt as a preventive measure against the risk of high blood pressure and other possible harm from excess consumption of salt. This dietary advice from the WHO sets a limit on the dietary intake of salt at 6g per day. (British Nutrition Foundation, 1994). In the United Kingdom the Scientific Advisory Committee on Nutrition (SACN) recommendation is in keeping with the dietary advice of WHO, which proposes that the daily dietary intake of salt should not exceed 6g per day (Fighting salt in UK consumer diet). The advice from the Scientific Advisory Committee on Nutrition (SACN) was based on recommendations of the advice emerging from the Committee panel and Review Group that evaluated the dietary requirement of sodium through the intake of salt. The Committee on Medical Aspects of Food Policy (COMA) panel on Dietary Reference Values (DRV) has come up with the advice that the daily intake of sodium should be less than 3.2g, which works out to 8.4g of salt and set the value for sodium intake in the Reference Nutrient Intake (RNI) at 1.6g per day, which works out to a daily salt intake 4.2g of salt for men and women. The COMA Cardiovascular Review Group has recommended that the daily average of salt intake should be less than 6g per day, which is in keeping with the WHO recommendations. These recommendations were endorsed by the Chief Medical Officer of England, which then got reflected in the proposal of the Scientific Advisory Committee on Nutrition (SACN) to keep the level of salt intake un the United Kingdom at less than 6g per day (National Centre for Social Research, 2006). 4. Perceptions of Public in the United Kingdom on Dietary Role of Salt: There is limited understanding of the role that diet plays in the case of personal risk to high cardiovascular diseases like high blood pressure and stroke in the United Kingdom. The importance of the risk to these diseases and the awareness of the role that diet plays in these diseases become heightened only when there is an experience of any of these diseases in the family. This results in a limited awareness of the role that the excess intake of salt plays in the development of these diseases, though there is the awareness that risks for these diseases need to be reduced in preventing their onset (Dawson, 2004). In the United Kingdom the dietary and nutrition information dissemination is essentially the role of the Food Standards Agency (FSA). This information for the consumers is disseminated through several forms. The low awareness of the dietary role salt, the recommended daily intake and the risks posed by excess consumption of salt can be taken as the result of several factors that include lack of information and media campaigns; ignorance of the sources from which salt becomes a part of dietary intake and the lack of use of food labelling as well as the comprehension of food labelling, when it is used. Addressing these factors remains crucial in the attempts to ensure that the daily intake of salt is at the recommended levels. When the majority of the people are not aware of how much of salt to consume or which are the sources of from which salt enters their diet, besides the salt that is added by them in the preparation of food or during the consumption, they cannot be expected to make efforts to keep in line with the recommended daily intake of salt. Compounding this issue is the labelling on food products that make it difficult for the public to understand the content of sodium or salt in manufactured food products (Bower & Schroder, 2007). This lack of awareness among a majority of the people in the United Kingdom on the role of dietary salt and the sources from where it is derived in the diet of an individual has caused the awareness campaign of FSA through the Sid the slug campaign that carries the strap line “Salt – watch it” (Mutel, 2004). 5. Consumption of Salt in the United Kingdom: The consumption of sodium in a day can be ascertained from the quantity of sodium excreted through urine over a period of 24 hrs, as this is the pathway taken by sodium in the body under normal circumstances and sodium consumed in excess of the daily physiological requirements of the body is excreted through this pathway (National Centre for Social Research, 2006). The lack of awareness among the majority of the population in United Kingdom on the role of dietary salt and the sources from where it is derived in the diet is reflected in the consumption of salt in the United Kingdom. The average salt consumption in the United Kingdom works out to be approximately 10.1g per day among men and 7.7g per day in women, with it ranging from as low as 4g per day in men to a high of 18g per day and in women from a low of 3g per day to a high of 14g per day (British Nutrition Foundation, 1994). These figures demonstrate that the consumption of salt in the United Kingdom on an average is much higher in both men and women than the recommendations of WHO and the diet and health recommendatory bodies of 6g per day in men and women. Probing further into regional consumption of salt in the United Kingdom in the age group 19 to 64, shows that in England the average consumption of salt in men is 10.2g per day and in women it is 7.7g per day with the average consumption working out to 9g per day (National Centre for Social Research, 2006). In Wales the evaluation of salt consumption in the age group 19-64 shows that men on an average men consume 9.4g of salt per day, while women on an average consume 6.8g per day. The average consumption of salt in Wales works out to 8.1g per day (National Centre for Social Research, 2006). In Scotland the evaluation of the salt consumption in the age group 19-64 shows that men consume on an average 10.6g of salt per day, while the consumption of salt in women is 7.6g per day, with average consumption of salt in men and women in Scotland working out to 9.1g per day (National Centre for Social Research, 2006). These figures demonstrate that the consumption of salt is not even among the two genders and the different regions of the United Kingdom. Men in all the regions of the United Kingdom on an average consume more salt on a daily basis than females. In the case of the different regions, Wales demonstrates the lower average figures for daily salt consumption in comparison to England and Scotland, but even the average lower figures of salt consumption in Wales is above the recommended daily intake of 6g per day. This shows that families in the United Kingdom are consuming more salt than they should in their daily diet. This has repercussions for not just the adults and this generation, but for the children too and hence implications on the future generations, as McCullough, Yoo and Ainsworth, 2004, warn that diet and food preferences of children are moulded early through the dietary and food preference practices of their parents. 6. Sources of Dietary Salt in the United Kingdom: According to the Food Standards Agency (FSA), most of the population in the United Kingdom consume more salt than is required for the daily physiological requirements (Food Standards Agency). Why is this so? The answer possibly lies in this contention of Ellis, 2006, “six grams of salt is a level teaspoonful. It’s difficult to measure consumption because 65-85% of our salt is already in the foods we eat, and not what we add in cooking and at the table. Bread, breakfast cereals, biscuits, baked beans and ready-meals can be high in salt, alongside more obviously salty-tasting foods such as crisps, bacon, cheese and olives”. This contention tells us that a major portion of the salt that is consumed in the United Kingdom does not come from the salt that we add at the table or in the home food preparations. The contention also suggests that in the United Kingdom as is the case in most of the developed a larger proportion of the food consumed consists of manufactured food products with a smaller proportion of domestically prepared food products. The general public is unaware of this differentiation in the sources from which a major portion of the daily intake of salt ensues (Gibson, Armstrong & McIlveen, 2000). This is however, reflected in the blame that FSA has apportioned on the food manufacturing industry for the excess of daily salt consumption that is seen in the United Kingdom (Dunn, 2003). Any talk of salt consumption stirs up in the mind the general public the picture of domestic cooking as a favourite seasoning and as a preservative for food preparations that are made for staying. In the same manner manufactured food products use salt for taste purposes and as a preservative. The presence of salt in manufactured food products is high and has an impact on the continued consumption levels of salt. There is evidence to suggest that an individual’s daily intake of salt can be influenced by the habitual intake of salt in the consumption of food stuffs as the taste buds adjust for the intake of salt. Elevated or lower intake of salt cause the taste of the individual to adjust to a different optimum level of salt intake When salt is continuously consumed at higher levels the taste of the individual adjusts to higher levels of salt in the food and it in this aspect that the increased levels of salt in prepared and convenience foods have an impact not just on the current levels of salt intake, but on the continued higher levels of daily consumption of salt (British Nutrition Foundation, 2002). It becomes thus clear that the onus of the current elevated levels of slat intake lie with the many food product manufactures, as many of these foods contain a much higher level of salt that is required for flavouring and is the driving force behind the continued high levels of daily salt intake in the United Kingdom (Gibson, Armstrong & McIlveen, 2000). 7. Initiatives to Curb the Daily Consumption of Salt in the United Kingdom: We may console ourselves that the intake of salt in the Kingdom is less than the consumption of salt in comparison to our Eastern Europe counterparts (Steptoe & Wardle, 2001). However, the fact remains that the daily consumption of salt is well above the dietary requirements in the United Kingdom. It is for this reason that FSA has created guidance for the food industry recently, which sets voluntary salt reduction targets for 85 categories of food (Food Standards Agency, 2007). The rationale behind this approach of FSA is its belief that curbing of daily intake of salt in the United Kingdom is best achievable by targeting the major source of salt intake, which is the manufactured foods sector, through its contribution of nearly 75% of the intake of salt by an individual in the United Kingdom (Food Standards Agency, 2006). There is also the suggestion that in the case the food manufacturing industry does not voluntarily take steps to reduce the amount of salt in the prepared and convenience foods more coercive measures like the introduction of higher taxes on the manufactured foods not meeting the voluntary reduction targets (Mytton et al, 2007). An initiative for the curbing the intake of salt in home prepared foods and in salt addition at the table can be seen in the recent introduction the low-sodium salt brand LoSalt by John Ayling and Associates Co. in the United Kingdom (John Ayling to launch LoSalt healthy-eating ad campaign). 8. Results: Author Year Study Assessment Finding Comment Bower, A.J. & Schroder, A.J.M 2007 To investigate the effectiveness of consumer information and advice issued by FSA in terms of consumer understanding. 118 female respondents in Scotland answering a questionnaire. Most respondents indicated that they were health conscious and nutritionally aware, but showed limited awareness of the role of dietary salt. Findings limited to females and Scotland. Dawson, R.C. 2004 To explore the general understanding of heart disease and stroke and the role of salt in these diseases. Short interviews with the public on North West London an group discussions. Better awareness of heart disease and stroke. Limited awareness of the role of salt in these diseases. Findings limited to North West London. Denny, A. 2008 Role of diet in the aging process. Literature Review Good nutrition is essential for healthy ageing. Findings limited to the literature reviewed. Gibson, J., Armstrong, G. & McIlveen, H 2000 Impact of consumption of convenience foods on salt intake. Literature Review Largest proportion of salt intake is from processed foods. Findings limited to the literature reviewed. Kelly, C.N. & Stanner, S.A. 2003 Efficiency of dissemination of information on diet and cardiovascular diseases Literature Review More effective campaigns are required to spread the message of the benefits of healthy diet. Findings limited to the literature reviewed. McCullough, W.S.F., Yoo, S. & Ainsworth, P 2004 Food choice, nutritional education and parental influence on British and Korean primary children. Case Study Children identified parents as their main source of nutrition information. Findings based on a comparative study. Mytton, O., Gray, A., Rayner, M. & Rutter, H 2007 Impact of targeted food taxes improve public health Discussion Paper Taxing foodstuffs can have unpredictable health effects if cross-elasticities of demand are ignored. Perspectives of the authors. National Centre for Social Research 2006 An assessment of dietary sodium levels among adults (aged 19-64) in the general population, of England based on analysis of dietary sodium in 24 hour urine samples 24 hr urine analysis of volunteers In England the average consumption of salt in men is 10.2g per day and in women it is 7.7g per day with the average consumption working out to 9g per day Children, adolescents and the elderly above the age of 64 not a part of the study. National Centre for Social Research 2006 An assessment of dietary sodium levels among adults (aged 19-64) in the general population in Wales, based on analysis of dietary sodium in 24 hour urine samples 24 hr urine analysis of volunteers In Wales the average consumption of salt in men is 9.4g per day and in women it is 6.8g per day with the average consumption working out to 8.1g per day Children, adolescents and the elderly above the age of 64 not a part of the study. National Centre for Social Research 2006 A survey of 24 hour and spot urinary sodium and potassium excretion in a representative sample of the Scottish population 24 hr urine analysis of volunteer households In Wales the average consumption of salt in men is 10.6g per day and in women it is 7.6g per day with the average consumption working out to 9.1g per day Households are more representative of the cross-section of the population. 8. Conclusion: Salt is an essential part of our diet, because of its sodium content. Consumption of salt in excess of the physiological requirements of the human body increases the risk of diseases like high blood pressure and stomach cancer. In the United Kingdom the dietary intake of salt is in excess of the recommended 6g per day. A major portion of dietary salt comes from food products of the manufactured food industry and not from domestic use in cooking or at the table. FSA has set targets for the voluntary reduction of the percentage of salt in 85 products of the manufactured food industry with the hope that this reduction in the percentage of salt in these products would contribute to a reduction in the daily consumption of salt in the United Kingdom. Literary References Bower, A.J. & Schroder, A.J.M. 2007, ‘Consumer understanding of UK salt advice’, British Food Journal, 233-245. British Nutrition Foundation. 1994, ‘Salt in the Diet’ [Online] Available at: http://www.nutrition.org.uk/home.asp?siteId=43§ionId=780&subSectionId=341&parentSection=303&which (Accessed May 4, 2008). British Nutrition Foundation. 2002, “The role of salt in health”, Nutrition Bulletin, 27, 135-138. Dawson, R.C. 2004, ‘SALT CAMPAIGN: Understanding and perceptions of heart disease and stroke’. Food Standards Agency [Online] Available at: http://www.food.gov.uk/multimedia/pdfs/saltperceptions.pdf (Accessed May 4, 2008). Denny, A. 2008. ‘An overview of the role of diet during the ageing process’. British Journal of Community Nursing, vol.13, no.2, pp, 58-67. Dunn, J. (2003), ‘The good, the bad and the salty’, Food Manufacture, vol.78, pp.4-6. Ellis, H. 2006, ‘Salt: friend or foe?’ Food, bbc.co.uk [Online] Available at: http://www.bbc.co.uk/food/food_matters/salt.shtml (Accessed May 4, 2008). ‘Fighting salt in UK consumer diet’. 2004, FoodQualitynews.com [Online] Available at: http://www.foodqualitynews.com/news/ng.asp?id=50249-fighting-salt-in (Accessed May 4, 2008). Food Standards Agency. ‘Salt’ [Online] Available at: http://www.food.gov.uk/healthiereating/salt/ (Accessed May 4, 2008). Food Standards Agency. 2006, ‘Development of salt targets’ [Online] Available at: http://www.food.gov.uk/healthiereating/salt/devsalttargets Accessed May 4, 2008). Food Standards Agency. 2007, ‘Review of salt reduction targets’, [Online] Available at: http://www.food.gov.uk/healthiereating/salt/salttargetreview (Accessed May 4, 2008). Gibson, J., Armstrong, G. & McIlveen, H. 2000, ‘A case for reducing salt in processed foods’, Nutrition & Food Science, vol.30, no.4, pp.167-173. ‘John Ayling to launch LoSalt healthy-eating ad campaign’. 2008, Marketing Week, vol.31, no.5, pp. 14. Kelly, C.N. & Stanner, S.A. 2003, ‘Diet and cardiovascular disease in the UK: are the messages getting across? The Proceedings of the Nutrition Society, vol.62, no.3, pp.583-589. McCullough, W.S.F., Yoo, S. & Ainsworth, P. 2004, ‘Food choice, nutrition education and parental influence on British and Korean primary school children’, International Journal of Consumer Studies, vol.28, no.3, pp. 235-244. Mutel, G. 2004, ‘Sid the slug to urge British public to cut back on salt intake’, Campaign (UK), vol.38, pp.7. Mytton, O., Gray, A., Rayner, M. & Rutter, H. 2007, Could targeted food taxes improve health? Journal of epidemiology and community health, vol.61, no.8, pp.689-694. National Centre for Social Research. 2006, ‘An assessment of dietary sodium levels among adults (aged 19-64) in the general population, based on analysis of dietary sodium in 24 hour urine samples’. Joint Health Surveys Unit. [Online] Available at: http://www.food.gov.uk/multimedia/pdfs/englandsodiumreport.pdf (Accessed May 4, 2008). National Centre for Social Research. 2006, ‘An assessment of dietary sodium levels among adults (aged 19-64) in the general population in Wales, based on analysis of dietary sodium in 24 hour urine samples’. Joint Health Surveys Unit. [Online] Available at: http://www.food.gov.uk/multimedia/pdfs/walessodiumreport.pdf (Accessed May 4, 2008). National Centre for Social Research. 2006, ‘A survey of 24 hour and spot urinary sodium and potassium excretion in a representative sample of the Scottish population’. Joint Health Surveys Unit. [Online] Available at: http://www.food.gov.uk/multimedia/pdfs/scotlandsodiumreport.pdf (Accessed May 4, 2008). Nerys, W. 2005, ‘10 tips on … Diet, nutrition and health’. Practice Nurse, vol.29, no.12, pp.33-34. Steptoe, A. & Wardle, J. 2001, ‘Health behaviour, risk awareness and emotional well-being in students from Eastern and Western Europe’, Social Science and Medicine, vol.53, pp.1621-1630. Read More