Interventions to Reduce Sodium Consumption Through a Reduction in Salt Usage in Cooking-A Systematic Review and Meta-analysis

Abstract

Context: Public health experts have identified salt as a primary dietary risk factor, leading many countries worldwide, recognizing its cost-effectiveness, to implement salt-reduction programs to combat cardiovascular disease and other chronic illnesses. Some nations found that a substantial portion of dietary salt comes from cooking practices. Objectives: This systematic review aims to describe and assess the effectiveness of interventions aimed at decreasing salt usage in cooking. Data Sources: A search across Scopus, PubMed, and Web of Science was conducted to identify interventions from the past decade that target reduced salt usage during cooking, with effectiveness measured through 24-hour urinary sodium excretion. Data Extraction: Thirteen studies were ultimately included (comprising 5 intervention study protocols and 8 randomized controlled trials). Data Analysis: The interventions primarily focused on adult participants (n = 11). The interventions ranged from educational initiatives, education combined with salt-restricted utensils, warning labels on salt containers, substitution of salt with potassium-enriched low-sodium alternatives to the use of dosing devices for cooking at home. While 3 studies reported a significant reduction in urinary sodium excretion (mainly through educational efforts), others showed decreases without statistically significant differences between groups. The performed meta-analysis with data from 3185 participants indicated that interventions to reduce salt usage during cooking showed a significant trend towards reducing sodium intake (Hedges' g, -1.06; 95% CI, -1.68 to -0.44; P < .001). Conclusion: The findings suggest that interventions targeting reduced salt usage are effective on sodium intake reduction, assessed by 24-hour urinary sodium excretion, particularly among hypertensive individuals. This approach could aid in achieving the World Health Organization's goal of a 30% reduction in salt intake by 2030.