Response to Salt Intake in Children: Increasing Concerns?
We are very grateful to Schreuder et al1 for providing valuable new information on salt intake measured by 24-hour urinary sodium excretion in children in the Netherlands. Their results clearly show that salt intake in children is unnecessarily high and, if expressed as for an adult with a 70-kg body weight, salt intake would be 12 g per day in 1993–1995 and increased to 16 g per day by 2003–2005. It is likely that, in most developed countries, children’s salt intake is similar to that in the Netherlands. The increase in salt intake is attributable, in most countries, to the hidden salt added to food by the food industry. Surveys in the United States showed that the proportion of foods that children consumed from restaurants and fast food outlets increased by ≈300% between 1977 and 1996,2 and it is very likely to have increased even further in more recent years. Snack food consumption showed trends similar to those of fast food consumption. The processed, restaurant, and fast foods, including snacks, particularly those targeted at children, are very high in salt and calories, because they are usually very high in fat. The high salt content of these foods makes children thirsty, and this thirst is often assuaged by soft drinks, thereby compounding the increase in calorie intake.3 The finding by Schreuder et al,1 in conjunction with our meta-analysis of controlled salt reduction trials4 and other evidence, makes a very strong case for urgent action to reduce salt intake in children.
As in adults, ≈80% of salt intake in children in most developed countries comes from salt added to processed, restaurant, fast, and takeaway foods, and a reduction in salt intake, therefore, requires the cooperation of the food industry5 and can easily be done by making a gradual and sustained reduction in the salt content of all foods to which salt has been added. A strategy of small reductions, that is 10% to 20%, which cannot be detected by the human salt taste receptors, repeated at 1 to 2 yearly intervals, is slowly being achieved in the United Kingdom. Many of these foods are made by multinational companies that are not reducing the salt content of their food in other countries. There is an urgent need for all food companies to follow the example of the United Kingdom, particularly reducing the unnecessarily high salt content of foods currently targeted at children.
Schreuder MF, Bokenkamp A, van Wijk JAE. Salt intake in children: increasing concerns? Hypertension. 2007; 49: e10.
St-Onge MP, Keller KL, Heymsfield SB. Changes in childhood food consumption patterns: a cause for concern in light of increasing body weights. Am J Clin Nutr. 2003; 78: 1068–1073.
James J, Thomas P, Cavan D, Kerr D. Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial. BMJ. 2004; 328: 1237–1239.
He FJ, MacGregor GA. Importance of salt in determining blood pressure in children: meta-analysis of controlled trials. Hypertension. 2006; 48: 861–869.