Adults in China have been consistently consuming above 10g of salt a day – over double the recommended limit of 5g – for the last four decades, according to new research led by Queen Mary University of London. Meanwhile, children aged three to six are eating the maximum amount of salt recommended for adults, while older children eat almost 9g a day. This places Chinese salt intake among the highest in the world, although there is a North-South divide within the country. Too much salt leads to high blood pressure, a major cause of strokes and heart disease – which account for 40 percent of Chinese deaths.

Speaking exclusively with the report’s lead author, Monique Tan, from Queen Mary University of London, stresses the importance of salt reformulation in the wake of these findings and how differences in government-backed educational campaigns has impacted the results.

“Salt reformulation is essential, as processed foods contain unnecessarily high levels of salt and people of all socio-demographic status are consuming more of those products. When their salt content is reduced gradually over the years, evidence suggests that people cannot detect it,” she explains.

Another key finding was that there was a North-South divide, with northern China having a higher (11.2g) daily consumption than the South (10.2g). However, northern China’s salt intake has declined from 12.8g a day in the 1980s, while southern China’s intake has increased from 8.8g in the same period.

“The decline in the North could be explained by the government’s efforts in salt awareness education, as well as improvements over time in the year-round availability of fresh produce, which made people less reliant on using salt to preserve food. The rise in the South is most likely due to the salt reduction efforts being mitigated by the growing consumption of processed foods and out-of-home foods,” explains Tan.

The government would need to step in to achieve any significant salt reaction. “Unlike in Western countries wher salt mostly comes from processed foods, in China, it is generally added during cooking. This means that salt awareness education is still necessary for people to change their behavior.”

“At the same time, processed and out-of-home foods are becoming increasingly important contributors to salt intake, and if the government set maximum targets for the salt content of those foods, it would create a level playing field. Salt would be reduced across the board, and this would help guide the entire population to get accustomed to a less salty taste gradually,” Tan continues.

A consistently low potassium intake throughout China is exacerbating issues stemming from high salt intake. Naturally found in fruits and vegetables, potassium lowers blood pressure. However, Chinese people of all ages have been consuming less than half the recommended minimum intake over the past four decades.

“Foods could be reformulated by replacing the regular salt with potassium salt, which contains less sodium and more potassium. Potassium salt has been shown in randomized controlled trials to reduce blood pressure and cardiovascular mortality,” notes Tan.

The systematic meta-analysis was funded by the National Institute for Health Research and published in the Journal of the American Heart Association and reviewed all data ever published on Chinese salt intake, which included around 900 children and 26,000 adults.

The trends found are contradictory to elements of earlier studies which claimed salt intake decline was country-wide. The researchers say their results are more robust as salt intake was determined exclusively with data from urine samples taken over 24 hours, instead of self-reported surveys.

Action to accelerate salt reduction
There has been plenty of research into salt intake in China, and now action to accelerate salt reduction in the country is needed, according to Tan. This is necessary before all the hard-won declines get offset by the rapid rise in processed and out-of-home food consumption.

“A coherent, workable and nationwide strategy is urgently needed in China. As much as a fifth of the world’s population lives in China. Achieving salt reduction together with increasing potassium intake across the country would result in an enormous benefit for global health,” adds Graham MacGregor, Professor of Cardiovascular Medicine at Queen Mary University of London and Director of Action on Salt China.

Other Asian countries have also seen health shifts, with Malaysia having both the highest obesity prevalence in Southeast Asia, as well as high rates of undernutrition. Companies are being urged to reformulate their products to increase fiber and reduce salt and sugar.

Meanwhile, Thai consumers are interested in improving their diets, and most are happy for products to be reformulated, provided that taste is not compromised. The country faces similar nutrition issues to Malaysia, and businesses are also working to address the population’s health.