title: Impacts of a national strategy to reduce population salt intake in England: serial cross sectional study.
abstract: BACKGROUND
  The UK introduced an ambitious national strategy to reduce population levels of salt intake in 2003. The aim of this study was to evaluate the impact of this strategy on salt intake in England, including potential effects on health inequalities.
  
  
  METHODS
  Secondary analysis of data from the Health Survey for England. Our main outcome measure was trends in estimated daily salt intake from 2003-2007, as measured by spot urine. Secondary outcome measures were knowledge of government guidance and voluntary use of salt in food preparation over this time period.
  
  
  RESULTS
  There were significant reductions in salt intake between 2003 and 2007 (-0.175 grams per day per year, p<0.001). Intake decreased uniformly across all other groups but remained significantly higher in younger persons, men, ethnic minorities and lower social class groups and those without hypertension in 2007. Awareness of government guidance on salt use was lowest in those groups with the highest intake (semi-skilled manual v professional; 64.9% v 71.0% AOR 0.76 95% CI 0.58-0.99). Self reported use of salt added at the table reduced significantly during the study period (56.5% to 40.2% p<0.001). Respondents from ethnic minority groups remained significantly more likely to add salt during cooking (white 42.8%, black 74.1%, south Asian 88.3%) and those from lower social class groups (unskilled manual 46.6%, professional 35.2%) were more likely to add salt at the table.
  
  
  CONCLUSIONS
  The introduction a national salt reduction strategy was associated with uniform but modest reductions in salt intake in England, although it is not clear precisely which aspects of the strategy contributed to this. Knowledge of government guidance was lower and voluntary salt use and total salt intake was higher among occupational and ethnic groups at greatest risk of cardiovascular disease.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Laverty
authors.forename: Neophytos
authors.initials: N
authors.lastname: Stylianou
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
authors.forename: Utz J
authors.initials: UJ
authors.lastname: Pape
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001364:Awareness; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D015536:Down-Regulation; D004435:Eating / Q000502:physiology*; D004739:England / Q000453:epidemiology; D005260:Female; D006287:Health Planning Guidelines; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D011153:Population; D015397:Program Evaluation; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D017673:Sodium Chloride, Dietary