Developing the evidence base for a national salt reduction program for India

Background

High blood pressure caused by excess salt consumption is almost certainly a leading cause of premature death and disability in India with enormous potential for benefits to be achieved from effective, low cost and scalable intervention programs. Centrally implemented salt reduction has been identified as a priority intervention by multiple national and international agencies but the realization of effective strategies is being seriously hampered by an absence of key data for implementation and monitoring. Australia has a well-established salt reduction initiative driven by the Australian Chief Investigators (who lead the Australian Division of World Action on Salt and Health) with support from an NHMRC Partnership Grant, the NSW State government, the food industry and multiple non-governmental organisations. At the time the project started, India had no such program.

Aims

The overall goal of this 3-year project was to develop the evidence base required to formulate a national salt reduction program for India. This was done by conducting an integrated, multifaceted research program comprised of stakeholder assessments, population surveys and food supply evaluations. The aim was to provide the data required to formulate and implement a plausible national salt reduction program for India.

Project plan

The specific objectives for each research component were:

Stakeholder survey – to obtain a comprehensive understanding of consumer and other stakeholder opinions in relation to the most effective mechanisms for reducing salt intake: Face-to-face in-depth interviews with stakeholders from academia, industry, government, non-government and focus group discussions with consumers.
Population survey – to estimate the mean daily salt consumption of the Indian population, the main sources of salt in the diet, and population knowledge about the adverse effects of salt on health: 24hr urinary sodium excretion/spot urine samples; 24hr dietary recall survey; demography and anthropometry; knowledge, attitudes and behaviors on salt intake using a questionnaire.
Food survey – to estimate the mean and variation in the nutritional quality of common processed and restaurant foods: shop survey to capture nutrition information on packaged food available in Hyderabad and Delhi supermarkets.

Impact

This project set out to develop the evidence base for a national salt reduction programme tailored to the specific social and economic circumstances of India. The project team developed a branded food composition database, which includes information about the nutritional content of processed and fast foods.

Publications and output

GACD have published an end-of-programme report, providing a comprehensive summary of the programme and outcomes.