salt intake in finland

19.04.23

Salt intake in Finland

Pirjo Pietinen

Professor, Head of Nutrition Unit

National Public Health Institute

19.04.23 2

30 years of systematic work

• Recommendation to reduce salt intake by the National Nutrition Council in 1978

• 1979-1982 The North Karelia Salt project with population surveys in 1979 and 1982

• Mass media campaigns, cooperation with food industry to reduce salt voluntarily, education of health care personnel

• Expanded after the 3-year project to the whole country• The public became aware of salt and BP, regular

monitoring was established at KTL, and the first national labelling decrees were launched in the 1980s

19.04.23 3

Monitoring sodium excretion in Finland

24-h urinary collections:

• 1979: North Karelia Salt Project• 1982 and 1987: FINMONICA salt substudy

2002: FINRISK salt substudy

19.04.23 4

FINRISK study areas

Southwestern Finland 1982 -

Helsinki area 1992 -

North Karelia 1982-

Kuopio area 1982-

Oulu area 1997-

19.04.23 5

24-h sodium excretion

Laatikainen et al. Eur J Clin Nutr 2006

YEAR

Na

mm

ol

1979 1982 1987 2002

100

140

180

220

260

300

340

Men, North Karelia

Men, Kuopio area

Men, Southwestern Finland

Men, Helsinki area

Women, North Karelia

Women, Kuopio area

Women, Southwestern Finland

Women, Helsinki area

19.04.23 6

24-h sodium excretion as NaCl


YEAR

NaC

l g

1979 1982 1987 2002

68

1012

1416

1820

Men, North Karelia

Men, Kuopio area


Men, Helsinki area


Women, Kuopio area



19.04.23 7

24-h potassium excretion


YEAR

K m

mol

1979 1982 1987 2002

6080

100

120

Men, North Karelia

Men, Kuopio area


Men, Helsinki area


Women, Kuopio area



19.04.23 8

24-h sodium/potassium ratio


YEAR

Na

/ K

mm

ol

1979 1982 1987 2002

1.8

2.0

2.2

2.4

2.6

2.8

3.0

Men, North Karelia

Men, Kuopio area


Men, Helsinki area

YEAR

Na

/ K

mm

ol

1979 1982 1987 2002

1.8

2.0

2.2

2.4

2.6

2.8

3.0


Women, Kuopio area



19.04.23 9

24-h urine volume


YEAR

Vo

lum

e m

l

1979 1982 1987 2002

14

00

16

00

18

00

20

00

Men, North Karelia

Men, Kuopio area


Men, Helsinki area

YEAR

Vo

lum

e m

l

1979 1982 1987 2002

14

00

16

00

18

00

20

00


Women, Kuopio area



19.04.23 10

Monitoring salt intake in dietary surveys and FBS

• Findiet studies Dietary substudies of FINRISK surveys 1992: 3 day food diary 1997: 24-h recall 2002: 48-h recall 2007: 48-h recall Area, 10-year age group and sex stratified random

samples of the population aged 25-64 years

• Food Balance Sheets 1980, 1991 and 1997-1999

19.04.23 11

Daily sodium intake compared to 24-h sodium excretion.FINRISK 2002 salt substudy.

Men (n = 410) Women (n = 469)

Na excretion %

of intake

Significance Na excretion %

of intake

Significance

North Karelia 91 * 107 ns

Southwestern

Finland

107 ns 112 **

Helsinki area 94 ns 103 ns

All 97 ns 107 **

Reinivuo et al. Eur J Clin Nutr 2006

19.04.23 12

Quartiles of salt intake from 48-h recall and 24-hurinary collection. FINRISK 2002 salt substudy.


46

81

01

21

4

Quartile

Na

Cl g

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1 2 3 4

Urine48-h recall

Mean and 95% confidence interval

19.04.23 13

Salt intake in Finland 1977-2007

0

2

4

6

8

10

12

14

16

18

Laskettu, miehet

Diet. Women

24-h U, men

24-h U, women

Linear (24-h U,men)Linear (24-h U,women)Linear (Laskettu,miehet)Linear (Diet.Women)

g/vrk

Year

19.04.23 14

1 2 3 4 6

0

1

2

3

4

5

6

Inta

ke (

g)

DIPP Nutrition Study: Kyttälä P ym.

Intake of salt (g) in children by age group

n=567 n=230 n=471 n=554 n=713

age

19.04.23 15

1 2 3 4 6

0

200

400

600

800

1 000

intak

e (

mg

/MJ)

DIPP Nutrition Study: Kyttälä P ym.

Intake of salt (mg/MJ) in children by age group

n=567 n=230 n=471 n=554 n=713

age

19.04.23 16

Sources of salt. Food Balance Sheets 1980-1999.

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

1980 1991 1997-1999

YEAR

Na

Cl

g/d

ay

Milk products

Fat spreads

Bread

Sweet bakery

Meat products

Fish products

Prepared, canned or frozenfood, condiment sauces

Catering

Salt used in households

Other sodium sources


19.04.23 17

Labelling of salt until 1.7.2007

NaCl % limits

”Low-salt” ”Heavily salted”

Fresh bread max 0.7 >1.3

Crisp bread max 1.2 >1.7

Fat spreads max 1.0 >2.0

Processed meat max 1.2 >1.8

Cheese max 0.7 >1.4

Breakfast cereals max 1.0 >1.7

Processed fish max 1.0

Soups and sauces max 0.5

Meatloaf, caseroles max 0.5

19.04.23 18

Labelling of salt after1.1.2008

NaCl % limits

Food category ”Highly salty”

(reduced by 0.1 %)

”Reduced salt”

>25 % less salt than normal product

Fresh bread >1.2 max 0.9

Crisp bread >1.6 max 1.2

Cheese >1.3 max 1.0

Sausages >1.7 max 1.3

Cold whole meat cuts >1.9 max 1.4

Breakfast cereals >1.6 max 1.2

Soups, broths, sauces >0.9 max 0.7

Prepared and semi-prepared foods

>1.1 max 0.8

19.04.23 19

Compulsory labelling of salt:

• Cheese• Sausages and other meat products• Fish products• Bread, crisp bread and thin crisp bread• Broths, soups and sauces, also as powder

and concentrate• Other prepared or semi-prepared foods• Mixed spices containg table salt

19.04.23 20

Distribution of salt intake by choice of low or high-salt products. Findiet 2002.

0 5 10 15 20 25 30

0

e+

00

1

e-0

42

e

-04

3

e-0

44

e

-04

5

e-0

4

Salt intake g

De

nsi

tyLow-salt2Low-salt1Present situationHigh-salt1High-salt2

Men

19.04.23 21

0 5 10 15 20 25 30

0

e+

00

1

e-0

42

e

-04

3

e-0

44

e

-04

5

e-0

4

Salt intake g

De

nsi

tyLow-salt2Low-salt1Present situationHigh-salt1High-salt2

Women

Distribution of salt intake by choice of low or high-salt products. Findiet 2002.

19.04.23 22

Conclusions

• Reducing salt intake in the population requres long-lasting, systematic work

• National legislation works – especially setting maximum salt levels for normal products

• Consumer education is very important

• Overall agreement within Europe helps - food travels

19.04.23 23

Finnish Heart Association: Certification Label

salt intake in finland

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