国内外减盐干预策略和措施研究进展

范芳; 李英华

doi:10.11847/zgggws1137783

国内外减盐干预策略和措施研究进展

doi: 10.11847/zgggws1137783

范芳^{1, 2},
李英华^2, ,

1.
安徽医科大学公共卫生学院，安徽合肥 230032
2.
中国健康教育中心监测与评估部

基金项目: 英国国家健康研究院全球健康研究项目中英减盐项目（NIHR Global Health Research Unit Action on Salt China 16/136/77）

详细信息

作者简介:
范芳（1997 – ），女，四川崇州人，硕士在读，研究方向：公共营养；健康教育与健康促进

通讯作者:
李英华，E-mail：liyinghua729@sina.com

中图分类号: R 193
计量
- 文章访问数: 441
- HTML全文浏览量: 137
- PDF下载量: 49
- 被引次数: 0
出版历程
- 接收日期: 2021-12-20
- 网络出版日期: 2022-07-29
- 刊出日期: 2022-08-31

Salt reduction in the world – intervention strategies and measures: a progress review

FAN Fang^{1, 2},
LI Ying-hua^{2
, ,}

1.
School of Public Health, Anhui Medical University, Hefei, Anhui Province 230032, China

摘要

摘要: 非传染性疾病（NCDs）是全球死亡的主要原因，减少食盐摄入量被认为是降低NCDs患病风险最具成本效益的关键优先行动之一。世界上很多国家为了减少本国居民食盐摄入量，实施了一系列的减盐策略和措施，主要包括制定减盐政策、开展消费者健康教育、食品行业改进食品配方、实施包装正面标签计划等。本文对盐的来源、盐与健康以及国内外一些国家和地区有关减盐干预策略和措施及其取得的成果进行了综述, 以期为中国开展相关减盐行动提供参考。
- 减盐 /
- 干预 /
- 策略 /
- 措施
Abstract: Non-communicable diseases (NCDs) is the main cause of deaths around the world and salt reduction is considered as one of the most cost-effective priority actions to reduce the risk of NCDs. In order to reduce salt intake among residents, many countries in the world have implemented a series of salt reduction strategies and measures, such as establishing salt reduction policies, enhancing consumer health education, improving food formulations in the food industry, and implementing front-of-package labeling programs. This paper summarizes researches on source of salt, salt and health, as well as the strategies, measures and achievements of salt reduction intervention in some countries and regions, in order to provide references for carrying out relevant salt reduction actions in China.
- salt reduction /
- intervention /
- strategy /
- measure

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参考文献(96)

[1]	NCD Countdown 2030 Collaborators. NCD countdown 2030: worldwide trends in non-communicable disease mortality and progress towards sustainable development goal target 3.4[J]. The Lancet, 2018, 392(10152): 1072 – 1088. doi: 10.1016/S0140-6736(18)31992-5
[2]	Huang LP, Trieu K, Yoshimura S, et al. Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials[J]. BMJ, 2020, 368: m315.
[3]	Aburto NJ, Ziolkovska A, Hooper L, et al. Effect of lower sodium intake on health: systematic review and meta-analyses[J]. BMJ, 2013, 346: f1326. doi: 10.1136/bmj.f1326
[4]	He FJ, Li JF, MacGregor GA. Effect of longer term modest salt reduction on blood pressure: cochrane systematic review and meta-analysis of randomised trials[J]. BMJ, 2013, 346: f1325. doi: 10.1136/bmj.f1325
[5]	Mozaffarian D, Fahimi S, Singh GM, et al. Global sodium consumption and death from cardiovascular causes[J]. The New England Journal of Medicine, 2014, 371(7): 624 – 634. doi: 10.1056/NEJMoa1304127
[6]	Zhou MG, Wang HD, Zeng XY, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990 – 2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. The Lancet, 2019, 394(10204): 1145 – 1158. doi: 10.1016/S0140-6736(19)30427-1
[7]	中共中央, 国务院. “健康中国2030”规划纲要[EB/OL]. (2016 – 10 – 25). https://www.jkzgxd.cn/article/684635.
[8]	国务院. 国务院关于实施健康中国行动的意见[EB/OL]. (2019 – 06 – 24). https://www.jkzgxd.cn/article/684636.
[9]	国家卫生计生委办公厅, 体育总局办公厅, 全国总工会办公厅, 等. 关于印发全民健康生活方式行动方案(2017 — 2025年)的通知[EB/OL]. (2017 – 05 – 05). http://www.ncsxyy.com/news/hnews/2017-05-05/589.html.
[10]	国务院办公厅. 国务院办公厅关于印发中国防治慢性病中长期规划(2017 — 2025年)的通知[EB/OL]. (2017 – 02 – 14). http://www.gov.cn/zhengce/content/2017-02/14/content_5167886.htm.
[11]	国务院办公厅. 国务院办公厅关于印发国民营养计划(2017 — 2030年)的通知[EB/OL]. (2017 – 07 – 13). http://www.gov.cn/zhengce/content/2017-07/13/content_5210134.htm?gs_ws=weixin_636356994945697555.
[12]	洪洋, 姜华, 孟丑拴, 等. 高食盐摄入对人体健康的影响[J]. 食品安全质量检测学报, 2021, 12(7): 2618 – 2623.
[13]	Leung WTW, Butrum RR, Chang FH, et al. Food composition table for use in East Asia[M]. Rome: FAO, 1972.
[14]	Webster JL, Dunford EK, Neal BC. A systematic survey of the sodium contents of processed foods[J]. The American Journal of Clinical Nutrition, 2010, 91(2): 413 – 420. doi: 10.3945/ajcn.2009.28688
[15]	Ni Mhurchu C, Capelin C, Dunford EK, et al. Sodium content of processed foods in the United Kingdom: analysis of 44, 000 foods purchased by 21, 000 households[J]. The American Journal of Clinical Nutrition, 2011, 93(3): 594 – 600. doi: 10.3945/ajcn.110.004481
[16]	Centers for Disease Control and Prevention. Vital signs: food categories contributing the most to sodium consumption - United States, 2007 – 2008[J]. Morbidity and Mortality Weekly Report, 2012, 61(5): 92 – 98.
[17]	Lucko AM, Doktorchik C, Woodward M, et al. Percentage of ingested sodium excreted in 24-hour urine collections: a systematic review and meta-analysis[J]. The Journal of Clinical Hypertension, 2018, 20(9): 1220 – 1229. doi: 10.1111/jch.13353
[18]	Holbrook JT, Patterson KY, Bodner JE, et al. Sodium and potassium intake and balance in adults consuming self-selected diets[J]. The American Journal of Clinical Nutrition, 1984, 40(4): 786 – 793. doi: 10.1093/ajcn/40.4.786
[19]	Sawka MN, Montain SJ. Fluid and electrolyte supplementation for exercise heat stress[J]. The American Journal of Clinical Nutrition, 2000, 72(2 Suppl): 564S – 572S.
[20]	Sawka MN, Burke LM, Eichner ER, et al. American College of Sports Medicine position stand: exercise and fluid replacement[J]. Medicine and Science in Sports and Exercise, 2007, 39(2): 377 – 390. doi: 10.1249/mss.0b013e31802ca597
[21]	Bhat S, Marklund M, Henry ME, et al. A systematic review of the sources of dietary salt around the world[J]. Advances in Nutrition, 2020, 11(3): 677 – 686. doi: 10.1093/advances/nmz134
[22]	Shao S, Hua YC, Yang Y, et al. Salt reduction in China: a state-of-the-art review[J]. Risk Management and Healthcare Policy, 2017, 10: 17 – 28. doi: 10.2147/RMHP.S75918
[23]	Zhao F, Zhang P, Zhang L, et al. Consumption and sources of dietary salt in family members in Beijing[J]. Nutrients, 2015, 7(4): 2719 – 2730. doi: 10.3390/nu7042719
[24]	Tan M, He FJ, Ding JM, et al. Salt content of sauces in the UK and China: cross-sectional surveys[J]. BMJ Open, 2019, 9(9): e025623. doi: 10.1136/bmjopen-2018-025623
[25]	Mente A, O'Donnell M, Rangarajan S, et al. Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study[J]. The Lancet, 2018, 392(10146): 496 – 506. doi: 10.1016/S0140-6736(18)31376-X
[26]	段晓阳, 李敏, 祁志刚, 等. 高血压家族史和行为危险因素聚集与高血压患病关系[J]. 中国公共卫生, 2022, 38(2): 172 – 176. doi: 10.11847/zgggws1135107
[27]	Wang YJ, Yeh TL, Shih MC, et al. Dietary sodium intake and risk of cardiovascular disease: a systematic review and dose-response meta-analysis[J]. Nutrients, 2020, 12(10): 2934. doi: 10.3390/nu12102934
[28]	Mente A, O'Donnell M, Rangarajan S, et al. Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies[J]. The Lancet, 2016, 388(10043): 465 – 475. doi: 10.1016/S0140-6736(16)30467-6
[29]	Garofalo C, Borrelli S, Provenzano M, et al. Dietary salt restriction in chronic kidney disease: a meta-analysis of randomized clinical trials[J]. Nutrients, 2018, 10(6): 732. doi: 10.3390/nu10060732
[30]	Borrelli S, Provenzano M, Gagliardi I, et al. Sodium intake and chronic kidney disease[J]. International Journal of Molecular Sciences, 2020, 21(13): 4744. doi: 10.3390/ijms21134744
[31]	World Health Organization. Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consulta-tion[R]. Geneva: World Health Organization, 2003.
[32]	Waxman A. WHO global strategy on diet, physical activity and health[J]. Food and Nutrition Bulletin, 2004, 25(3): 292 – 302. doi: 10.1177/156482650402500310
[33]	WHO Forum on Reducing Salt Intake in Populations. Reducing salt intake in populations: report of a WHO forum and technical meeting[R]. Geneva: World Health Organization, 2007.
[34]	World Health Organization. Sixty-first World Health Assembly: resolutions and decisions: annexes[R]. Geneva: World Health Organization, 2008.
[35]	World Health Organization. Global strategy on diet, physical activity and health[R]. Geneva: World Health Organization, 2004.
[36]	World Health Organization. 2008 – 2013 action plan for the global strategy for the prevention and control of noncommunicable diseases[R]. Geneva: World Health Organization, 2008.
[37]	World Health Organization. Creating an enabling environment for population-based salt reduction strategies: report of a joint technical meeting held by WHO and the Food Standards Agency, United Kingdom[R]. Geneva: World Health Organization, 2010.
[38]	World Health Organization. Strategies to monitor and evaluate population sodium consumption and sources of sodium in the diet: report of a joint technical meeting convened by WHO and the Government of Canada[R]. Geneva: World Health Organiza-tion, 2011.
[39]	World Health Organization. First global ministerial conference on healthy lifestyles and noncommunicable disease control[R]. Geneva: World Health Organization, 2011.
[40]	United Nations. 2011 High level meeting on prevention and control of non-communicable diseases[R]. New York: United Nations, 2011.
[41]	World Health Organization. Guideline: sodium intake for adults and children[R]. Geneva: World Health Organization, 2012.
[42]	World Health Organization. Global action plan for the prevention and control of NCDs 2013 – 2020[R]. Geneva: World Health Organization, 2013.
[43]	World Health Organization. United Nations decade of action on nutrition 2016 – 2025[R]. Geneva: World Health Organiza-tion, 2019.
[44]	World Health Organization. Shake the salt habit: the SHAKE technical package for salt reduction[R]. Geneva: World Health Organization, 2016.
[45]	World Health Organization. Tackling NCDs: ‘Best Buys’ and other recommended interventions for the prevention and control of noncommunicable diseases[R]. Geneva: World Health Organiza-tion, 2017.
[46]	World Health Organization. WHO global sodium benchmarks for different food categories[R]. Geneva: World Health Organiza-tion, 2021.
[47]	Department of Health Staff. Nutritional aspects of cardiovascular disease: report of the cardiovascular review group committee on medical aspects of food policy[R]. London: Stationery Office, 1994.
[48]	MacGregor GA, Sever PS. Salt – overwhelming evidence but still no action: can a consensus be reached with the food industry?[J]. BMJ, 1996, 312(7041): 1287 – 1289. doi: 10.1136/bmj.312.7041.1287
[49]	Scientific Advisory Committee on Nutrition. Salt and Health[R]. Lindon, UK: Public Health England, 2003.
[50]	He FJ, Brinsden HC, MacGregor GA. Salt reduction in the United Kingdom: a successful experiment in public health[J]. Journal of Human Hypertension, 2014, 28(6): 345 – 352.
[51]	Cappuccio FP, Capewell S, Lincoln P, et al. Policy options to reduce population salt intake[J]. BMJ, 2011, 343: d4995.
[52]	Department for Health and the Food Standards Agency. Guide to Creating a Front of Pack (FoP) nutrition label for pre-packed products sold through retail outlets[EB/OL]. [2021 – 11 – 18]. https://www.food.gov.uk/sites/default/files/media/document/fop-guidance_0.pdf.
[53]	Wyness LA, Butriss JL, Stanner SA. Reducing the population's sodium intake: the UK Food Standards Agency's salt reduction programme[J]. Public Health Nutrition, 2012, 15(2): 254 – 261. doi: 10.1017/S1368980011000966
[54]	Brinsden HC, He FJ, Jenner KH, et al. Surveys of the salt content in UK bread: progress made and further reductions possible[J]. BMJ Open, 2013, 3(6): e002936. doi: 10.1136/bmjopen-2013-002936
[55]	Hashem KM, He FJ, Jenner KH, et al. Cross-sectional survey of salt content in cheese: a major contributor to salt intake in the UK[J]. BMJ Open, 2014, 4(8): e005051. doi: 10.1136/bmjopen-2014-005051
[56]	Public Health England. Salt reduction targets for 2017[R]. London, UK: Public Health England, 2017.
[57]	Public Health England. Salt reduction targets for 2024[R]. London, UK: Public Health England, 2020.
[58]	Public Health England. National diet and nutrition survey: assessment of salt intake from urinary sodium in adults (aged 19 to 64 years) in England, 2018 to 2019[R]. London, UK: Public Health England, 2020.
[59]	WASSH. Action on Salt and World Awareness Weeks, 2005[EB/OL]. [2021 – 11 – 17]http://www.worldactiononsalt.com/.
[60]	Henney JE, Taylor CL, Boon CS. Strategies to reduce Sodium intake in the united states[R]. Washington, DC: The National Academies Press, 2010.
[61]	NYC Health. Cut the Salt, 2010[EB/OL]. [2021 – 11 – 17]. https://www1.nyc.gov/assets/doh/downloads/pdf/public/dohmhnews17-02.pdf
[62]	U. S. Food and Drug Administration. Menu labeling rule: key facts for industry[EB/OL]. [2021 – 11 – 17].https://www.fda.gov/media/116000/download.
[63]	NYC Health. Sodium Warning Rule in NYC Chain Restaurants, 2016[EB/OL]. [2021 – 11 – 17].https://www1.nyc.gov/site/doh/health/health-topics/national-salt-reduction-initiative.page.
[64]	Board of Health, Department of Public Health of Philadelphia. Mayor Kenney signs chain restaurant sodium menu labeling bill into law, 2018[EB/OL]. [2021 – 11 – 17].https://www.phila.gov/2018-09-14-mayor-kenney-signs-chain-restaurant-sodium-menu-labeling-bill-into-law/.
[65]	U. S. Food and Drug Administration. Sodium reduction[EB/OL]. [2021 – 11 – 17]. http://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm253316.htm.
[66]	U. S. Food and Drug Administration. FDA food categories and voluntary targets[R]. Washington, DC: U. S. Food and Drug Administration, 2021.
[67]	U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary guidelines for Americans, 2020 – 2025[R]. Washington, DC: U. S. Food and Drug Administration, 2020.
[68]	Centers for Disease Control and Prevention. Million hearts^®: meaningful progress 2012 – 2016[EB/OL]. [2021 – 11 – 17].https://millionhearts.hhs.gov/files/MH-meaningful-progress.pdf.
[69]	Centers for Disease Control and Prevention. Sodium Reduction in Communities Program (SRCP)[EB/OL]. [2021 – 11 – 17].https://www.cdc.gov/dhdsp/programs/sodium_reduction.htm.
[70]	NYC. Look before you eat! Promoting and protecting the city′s health[EB/OL]. [2021 – 11 – 18].https://www1.nyc.gov/site/doh/health/health-topics/heart-disease-choose-less-sodium.page.
[71]	U. S. Department of Agriculture, Agricultural Research Service. Nutrient intakes from food and beverages: mean amounts consumed per individual, by gender and age, what we eat in America, NHANES 2017 – 2018[R]. Washington, DC: U.S. Department of Agriculture, Agricultural Research Service, 2022.
[72]	Webster J, Dunford E, Kennington S, et al. Drop the Salt! Assessing the impact of a public health advocacy strategy on Australian government policy on salt[J]. Public Health Nutrition, 2014, 17(1): 212 – 218. doi: 10.1017/S1368980012004806
[73]	Webster J, Dunford E, Huxley R, et al. The development of a national salt reduction strategy for Australia[J]. Asia Pac J Clin Nutr, 2009,18(3): 303 – 309.
[74]	Elliott T, Trevena H, Sacks G, et al. A systematic interim assessment of the Australian Government′s Food and Health Dialogue[J]. Medical Journal of Australia, 2014, 200(2): 92 – 95.
[75]	Dunford E, Trevena H, Goodsell C, et al. FoodSwitch: a mobile phone app to enable consumers to make healthier food choices and crowdsourcing of National Food Composition Data[J]. JMIR mHealth and uHealth, 2014, 2(3): e37. doi: 10.2196/mhealth.3230
[76]	Eyles H, McLean R, Neal B, et al. Using mobile technology to support lower-salt food choices for people with cardiovascular disease: protocol for the SaltSwitch randomized controlled trial[J]. BMC Public Health, 2014, 14: 950. doi: 10.1186/1471-2458-14-950
[77]	Webster J, Trieu K, Dunford E, et al. Salt reduction in Australia: from advocacy to action[J]. Cardiovascular Diagnosis and Therapy, 2015, 5(3): 207 – 218.
[78]	Commonwealth of Australia. Health Star Rating System. Canberra: Commonwealth of Australia, 2015[EB/OL]. [2021 – 11 – 18]. http://www.healthstarrating.gov.au/internet/healthstarrating/publishing.nsf/content/home.
[79]	Australian Government Department of Health. Partnership reformulation program[EB/OL]. [2021 – 11 – 18].https://www.health.gov.au/initiatives-and-programs/healthy-food-partnership/partnership-reformulation-program.
[80]	Nowson C, Lim K, Grimes C, et al. Dietary salt intake and discretionary salt use in two general population samples in Australia: 2011 and 2014[J]. Nutrients, 2015, 7(12): 10501 – 10512. doi: 10.3390/nu7125545
[81]	Karppanen H, Mervaala E. Sodium intake and hypertension[J]. Progress in Cardiovascular Diseases, 2006, 49(2): 59 – 75. doi: 10.1016/j.pcad.2006.07.001
[82]	Laatikainen T, Pietinen P, Valsta L, et al. Sodium in the Finnish diet: 20-year trends in urinary sodium excretion among the adult population[J]. European Journal of Clinical Nutrition, 2006, 60(8): 965 – 970. doi: 10.1038/sj.ejcn.1602406
[83]	Pietinen P, Männistö S, Valsta LM, et al. Nutrition policy in Finland[J]. Public Health Nutrition, 2010, 13(6A): 901 – 906. doi: 10.1017/S1368980010001072
[84]	Sasaki N. The salt factor in apoplexy and hypertension: epidemiological studies in Japan[M]//Yamori Y. Prophylactic Approach to Hypertensive Diseases. New York: Raven Press, 1979.
[85]	National Institute of Health and Nutrition. Health Japan 21 (the second term): National Health and Nutrition Survey[EB/OL]. [2021 – 11 – 18].https://www.nibiohn.go.jp/eiken/kenkounippon21/kenkounippon21/mokuhyou.html#mokuhyou05.
[86]	Bertram MY, Steyn K, Wentzel-Viljoen E, et al. Reducing the sodium content of high-salt foods: effect on cardiovascular disease in South Africa[J]. South African Medical Journal, 2012, 102(9): 743 – 745. doi: 10.7196/SAMJ.5832
[87]	Swanepoel B, Schutte AE, Cockeran M, et al. Sodium and potassium intake in South Africa: an evaluation of 24-hour urine collections in a white, black, and Indian population[J]. Journal of the American Society of Hypertension, 2016, 10(11): 829 – 837. doi: 10.1016/j.jash.2016.08.007
[88]	Xu AQ, Ma JX, Guo XL, et al. Association of a province-wide intervention with salt intake and hypertension in Shandong Province, China, 2011 – 2016[J]. JAMA Internal Medicine, 2020, 180(6): 877 – 886. doi: 10.1001/jamainternmed.2020.0904
[89]	董静, 徐建伟, 刘海燕, 等. 2011 — 2016年山东省食品生产企业减盐干预效果评价[J]. 中国慢性病预防与控制, 2020, 28(7): 505 – 508.
[90]	He FJ, Wu YF, Feng XX, et al. School based education programme to reduce salt intake in children and their families (School-EduSalt): cluster randomised controlled trial[J]. BMJ, 2015, 350: h770. doi: 10.1136/bmj.h770
[91]	He FJ, Zhang PH, Li Y, et al. Action on salt China[J]. The Lancet, 2018, 392(10141): 7 – 9. doi: 10.1016/S0140-6736(18)31138-3
[92]	Zhang PH, He FJ, Li Y, et al. Reducing salt intake in China with “Action on Salt China” (ASC): protocol for campaigns and randomized controlled trials[J]. JMIR Research Protocols, 2020, 9(4): e15933. doi: 10.2196/15933
[93]	He FJ, Zhang PH, Luo R, et al. An application-based programme to reinforce and maintain lower salt intake (AppSalt) in school-children and their families in China[J]. BMJ Open, 2019, 9(7): e027793. doi: 10.1136/bmjopen-2018-027793
[94]	沈丹洋, 张晓畅, 殷召雪, 等. 中国六地区家庭主厨和家庭成员减盐相关知信行现状[J]. 中国公共卫生, 2021, 37(6): 939 – 942. doi: 10.11847/zgggws1131624
[95]	国务院新闻办公室. 《中国居民营养与慢性病状况报告 (2020年)》发布会图文实录[EB/OL]. (2020 – 12 – 23)[2021 – 11 – 18]. http://www.scio.gov.cn/xwfbh/xwbfbh/wqfbh/42311/44583/wz44585/Document/1695276/1695276.htm?from=timeline.
[96]	Santos JA, Tekle D, Rosewarne E, et al. A systematic review of salt reduction initiatives around the world: a midterm evaluation of progress towards the 2025 global non-communicable diseases salt reduction target[J]. Advances in Nutrition, 2021, 12(5): 1768 – 1780. doi: 10.1093/advances/nmab008