Salt intake in Finland

1. Salt intake in Finland Pirjo Pietinen Professor, Head of Nutrition Unit National Public Health Institute

2. 30 years of systematic work • Recommendation to reduce salt intake by the National Nutrition Council in 1978 • 1979-1982 The North Karelia Salt project with population surveys in 1979 and 1982 • Mass media campaigns, cooperation with food industry to reduce salt voluntarily, education of health care personnel • Expanded after the 3-year project to the whole country • The public became aware of salt and BP, regular monitoring was established at KTL, and the first national labelling decrees were launched in the 1980s

3. Monitoring sodium excretion in Finland 24-h urinary collections: • 1979: North Karelia Salt Project • 1982 and 1987: FINMONICA salt substudy • 2002: FINRISK salt substudy

4. FINRISK study areas Oulu area 1997- Kuopio area 1982- North Karelia 1982- Southwestern Finland 1982 - Helsinki area 1992 -

5. 24-h sodium excretion Laatikainen et al. Eur J Clin Nutr 2006

6. 24-h sodium excretion as NaCl Laatikainen et al. Eur J Clin Nutr 2006

7. 24-h potassium excretion Laatikainen et al. Eur J Clin Nutr 2006

8. 24-h sodium/potassium ratio Laatikainen et al. Eur J Clin Nutr 2006

9. 24-h urine volume Laatikainen et al. Eur J Clin Nutr 2006

10. Monitoring salt intake in dietary surveys and FBS • Findiet studies • Dietary substudies of FINRISK surveys • 1992: 3 day food diary • 1997: 24-h recall • 2002: 48-h recall • 2007: 48-h recall • Area, 10-year age group and sex stratified random samples of the population aged 25-64 years • Food Balance Sheets 1980, 1991 and 1997-1999

11. Daily sodium intake compared to 24-h sodium excretion.FINRISK 2002 salt substudy. Reinivuo et al. Eur J Clin Nutr 2006

12. Quartiles of salt intake from 48-h recall and 24-hurinary collection. FINRISK 2002 salt substudy. Reinivuo et al. Eur J Clin Nutr 2006

13. Salt intake in Finland 1977-2007 g/vrk Year

14. Intake of salt (g) in children by age group age n=567 n=230 n=471 n=554 n=713 DIPP Nutrition Study: Kyttälä P ym.

15. Intake of salt (mg/MJ) in children by age group age n=567 n=230 n=471 n=554 n=713 DIPP Nutrition Study: Kyttälä P ym.

16. Sources of salt. Food Balance Sheets 1980-1999. Reinivuo et al. Eur J Clin Nutr 2006

17. Labelling of salt until 1.7.2007

18. Labelling of salt after1.1.2008

19. Compulsory labelling of salt: • Cheese • Sausages and other meat products • Fish products • Bread, crisp bread and thin crisp bread • Broths, soups and sauces, also as powder and concentrate • Other prepared or semi-prepared foods • Mixed spices containg table salt

20. Distribution of salt intake by choice of low or high-salt products. Findiet 2002.

21. Distribution of salt intake by choice of low or high-salt products. Findiet 2002.

22. Conclusions • Reducing salt intake in the population requres long-lasting, systematic work • National legislation works – especially setting maximum salt levels for normal products • Consumer education is very important • Overall agreement within Europe helps - food travels

23. Finnish Heart Association: Certification Label