Sources of Dietary Salt in North and South India Estimated from 24 Hour Dietary Recall

Abstract

Recent data on salt intake levels in India show consumption is around 11 g per day, higher than the World Health Organization’s (WHO) recommended intake of 5 g per day. However, high-quality data on sources of salt in diets to inform a salt reduction strategy are mostly absent. A cross-sectional survey of 1283 participants was undertaken in rural, urban, and slum areas in North (n = 526) and South (n = 757) India using an age-, area-, and sex-stratified sampling strategy. Data from two 24-h dietary recall surveys were transcribed into a purpose-built nutrient database. Weighted salt intake was estimated from the average of the two recall surveys, and major contributors to salt intake were identified. Added salt contributed the most to total salt intake, with proportions of 87.7% in South India and 83.5% in North India (p < 0.001). The main food sources of salt in the south were from meat, poultry, and eggs (6.3%), followed by dairy and dairy products (2.6%), and fish and seafood (1.6%). In the north, the main sources were dairy and dairy products (6.4%), followed by bread and bakery products (3.3%), and fruits and vegetables (2.1%). Salt intake in India is high, and this research confirms it comes mainly from added salt. Urgent action is needed to implement a program to achieve the WHO salt reduction target of a 30% reduction by 2025. The data here suggest the focus needs to be on changing consumer behavior combined with low sodium, salt substitution.

Rationale, design, and baseline characteristics of the Salt Substitute in India Study (SSiIS): The protocol for a double‐blinded, randomized‐controlled trial

“…At the second study visit, participants who provided complete 24‐hour urine specimens were randomized and provided with study salt substitute or regular salt for the next three months, and an appointment was made for the 1‐month follow‐up visit (third visit). Additionally, dietary sources of sodium were assessed through an interviewer‐administered 24‐hour dietary recall survey 14 …”

“…A multiple pass 24‐hour dietary recall method 14 was used, through a questionnaire that was administered via face‐to‐face interviews by field staff. Data from 24‐hour dietary recall surveys were transcribed into a purpose‐built nutrient database, with nutrient composition data based on the Indian Food Composition Tables, 28 which was developed by the Indian National Institute of Nutrition.…”

“…Staff were trained in the administration of dietary recall surveys following the methodology developed by the Agricultural Research Service of the US Department of Agriculture 29 . Members of the research team have conducted such dietary surveys previously in India 14 . Discretionary salt intake was estimated by asking participants about the quantity of salt added during food preparation and prior to consumption.…”

“…Discretionary salt intake was estimated by asking participants about the quantity of salt added during food preparation and prior to consumption. Participants were asked to estimate the amount of salt added with the use of a food model booklet 14 . Interviewer prompts were provided to account for variable recipe ingredients and food preparation techniques 14,30 …”

“…In low‐ and middle‐income countries, the predominant dietary source of sodium is often from homemade foods where salt (sodium chloride) is added during food preparation (discretionary salt use) 13 . In India, more than 80 percent of dietary sodium is estimated to come from discretionary salt use 14 . Hence, strategies that reduce sodium from discretionary salt use are promising for lowering population‐level sodium consumption.…”