A high sodium intake is associated with metabolic health problems, including high blood pressure, an increased risk of cardiovascular diseases, and other chronic conditions. Past research has shown that excessive sodium intake led to 1.7 million deaths in China in 2017.

In China, the average salt intake is 11 g per day – more than twice the 5 g daily intake that is recommended by the World Health Organization (WHO). While around 80% of people’s sodium intake comes from table salt and condiments added during cooking, packaged and processed foods have become increasingly prominent in the Chinese diet in recent years.

With this in mind, the scientists behind this study combined nutrition data from 51,803 packaged food products with food consumption data from 15,670 Chinese adults to determine current intake and the potential impact of different reduction targets.

Biggest contributors: Soy sauce, condiments, and ready-to-eat meals

Publishing their findings in the WHO Bulletin, they found that processed foods provide adults with 1,302.5 mg of sodium each day, equivalent to 3.3 g of salt, or 30.1% of an adult’s daily sodium intake.

They also calculated that maximum sodium content levels based on revised WHO 20% reduction targets would result in “substantial and acceptable reductions in sodium content for most food subcategories,” reducing sodium intake by an estimated 305 mg/day per person. Overall population intake would fall by 6.1%.

“This study provides the scientific rationale for government policy on setting targets for food sodium content in China,” wrote the team of researchers, led by Professor Puhong Zhang, associate director at the George Institute for Global Health, China, and lead author of the study. “Simultaneous action on discretionary salt use should also be taken,” Zhang added.

Soy sauce and fish sauce contributed most to sodium intake (accounting for 47.3% of the 1,302.5 mg/day from all pre-packaged foods), followed by ready-to-eat meals, butter, margarine, and oil-based spreads.

Industry reformulation ‘easier’ than changing people’s cooking habits

The Chinese government implemented a national salt reduction programme in 2016 – mostly targeting households – that has successfully led to a significant reduction in household salt use. However, the researchers would like to see more efforts from the food industry.

Zhang called for a strengthening of reformulation strategies.

“… our study has shown that the contribution of pre-packaged food contributes to salt intake has grown and its market share is increasing. Considering that harnessing the food industry’s capacity to reduce salt in its products is much easier and more sustainable than changing people’s cooking and dietary behaviour, we strongly suggest deepening action on salt by simultaneously implementing sodium target-setting in China.”

Professor Huijun Wang from the National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, and co-author of the WHO Bulletin study said that global experience has proved industrial reformulation of processed products through target-setting is “a key solution” to lower the sodium intake.

“To start with the policy in China, the revised 20%-reduction targets could be a good choice because these targets can help push the reformulation of products with relatively high sodium content and guarantee substantial sodium content reduction, which may not be noticed by consumers and should be acceptable by most companies,” she added.

Food manufacturers selling products in China are required by law to list the sodium content on packaged food products’ labelling but there is no official regulation to incentivise the industry to reduce salt use, wrote the researchers in the WHO Bulletin study.

While a set of voluntary sodium targets were included in the Guideline for Salt Reduction for the Chinese Food Industry, published in 2019, the recommended mean and maximum levels were calculated based on data from only 9,000 food products, they noted, making it of limited use.