title: Population-level interventions in government jurisdictions for dietary sodium reduction: a Cochrane Review.
abstract: Worldwide, excessive salt consumption is common and is a leading cause of high blood pressure. Our objectives were to assess the overall and differential impact (by social and economic indicators) of population-level interventions for dietary sodium reduction in government jurisdictions worldwide.
  
  
  
  This is a Cochrane systematic review. We searched nine peer-reviewed databases, seven grey literature resources and contacted national programme leaders. We appraised studies using an adapted version of the Cochrane risk of bias tool. To assess impact, we computed the mean change in salt intake (g/day) from before to after intervention.
  
  
  
  Fifteen initiatives met the inclusion criteria and 10 provided sufficient data for quantitative analysis of impact. Of these, five showed a mean decrease in salt intake from before to after intervention including: China, Finland (Kuopio area), France, Ireland and the UK. When the sample was constrained to the seven initiatives that were multicomponent and incorporated activities of a structural nature (e.g. procurement policy), most (4/7) showed a mean decrease in salt intake. A reduction in salt intake was more apparent among men than women. There was insufficient information to assess differential impact by other social and economic axes. Although many initiatives had methodological strengths, all scored as having a high risk of bias reflecting the observational design. Study heterogeneity was high, reflecting different contexts and initiative characteristics.
  
  
  
  Population-level dietary sodium reduction initiatives have the potential to reduce dietary salt intake, especially if they are multicomponent and incorporate intervention activities of a structural nature. It is important to consider data infrastructure to permit monitoring of these initiatives.
authors.affiliation: Department of Community Health Sciences.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Barberio
authors.affiliation: Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Nureen
authors.initials: N
authors.lastname: Sumar
authors.affiliation: Food Policy, George Institute for Global Health, University of Sydney, Camperdown, NSW, Australia.
authors.forename: Kathy
authors.initials: K
authors.lastname: Trieu
authors.affiliation: Department of Community Health Sciences.|Institute of Health Economics, Edmonton, AB, Canada.
authors.forename: Diane L
authors.initials: DL
authors.lastname: Lorenzetti
authors.affiliation: Department of Nutritional Science, University of Toronto, Toronto, ON, Canada.
authors.forename: Valerie
authors.initials: V
authors.lastname: Tarasuk
authors.affiliation: Food Policy, George Institute for Global Health, University of Sydney, Camperdown, NSW, Australia.
authors.forename: Jacqui
authors.initials: J
authors.lastname: Webster
authors.affiliation: Department of Community Health Sciences.
authors.forename: Norman R C
authors.initials: NRC
authors.lastname: Campbell
authors.affiliation: Department of Community Health Sciences.
authors.forename: Lindsay
authors.initials: L
authors.lastname: McLaren
mesh_terms: D006076:Government; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D011634:Public Health; D012307:Risk Factors; D012982:Sodium, Dietary / Q000008:administration & dosage*
chemical_list: D012982:Sodium, Dietary
keywords: Population; equity; government; intervention; policy; salt