OFFICIAL OÉTI ONLINE PUBLICATION 2010
IMPLEMENTATION OF THE
HUNGARIAN SALT REDUCTION PROGRAM
BACKGROUND
Salt intake and cardiovascular diseases
Scientific evidence shows a positive association between salt intake and blood
pressure both in child and adulthood. This association holds for people with normal
and with high blood pressure. High blood pressure is a known independent risk
factor for cardiovascular diseases as well as for cerebro-vascular diseases. The
cardiovascular risk of overweight and obese people is increased even more with
excess salt intake. In the non-medical treatment of hypertonia, through decreased
salt intake a 2-8 Hgmm decrease of blood pressure can be achieved that mitigates
the mortality risk of stroke by 22% and 16% in the case of ischemic heart disease. A
population-based primer prevention strategy that builds on the lowering of salt
consumption in as early age as possible is able to reduce the main cardiovascular risk
i.e. high blood pressure thereby will contribute to the cardiovascular health of the
present and future generation.
EC Salt Reduction Framework Programme
One of the main priority areas of the EU White Paper on Nutrition, Overweight and
Obesity-related health issues published in May 2007 is the healthier food supply by
reformulation. It is known that in the majority of EU member states 75% of salt
intake of the population comes from processed food.
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In order to support and facilitate the national salt reduction programs, the High Level
Group – based on the Commission’s initiative – had decided to establish a salt
reduction framework programme in order to implement the strategy’s priority on
healthier food supply in the EU. Salt reformulation became one of the first action
areas as its implementation is technically not too complicated and there are many
successful practices from member states such England, Finland or Ireland. In
addition, salt reformulation could be a good example for reformulation in other areas
such as sugar, saturated fatty-acid, etc.
The main goal of the framework program is the EU wide salt reformulation on as
many food products as possible for equal and wide access to low salt food products
and to change people’s attitude for such products. The main action areas of the
framework programme are the assessment of the present situation; identification of
main food categories to be involved in the reformulation by the industry such as
bread, meat products, cheese, ready meals, and also soups, wheat products, canned
fish, chips, food in public catering, sauces, seasonings, potato products;
reformulation by the industry and public catering; awareness raising population
campaigns; monitoring and evaluation.
It is suggested that the reformulation should bring within 4 years a 16% decrease in
salt, 4% annually taking gradual implementation in consideration. The main goal is
that people should gradually reach the daily 5 gram salt intake recommended by the
WHO. Hungary by joining the initiative of the European Commission undertook to
decrease the salt content of the most widely consumed food groups by 16% in four
years.
IMPLEMENTATION OF THE SALT REDUCTION PROGRAMME IN HUNGARY
Measuring salt content of different food products
The National Institute for Food and Nutrition Science collected and measured the salt
content of 436 food samples belonging to different food groups. The samples were
measured in the Institute’s laboratory accredited according to the pertinent standard
laboratory procedures. Our results show that the different food products within a
food group had very different salt content. In international comparison the salt
content of bread, bakery product and meat products have very high salt content.
Sauces, salad dressings, soup powders, artificial seasonings had extremely high level
of salt. Practically there is no lowered salt content food product in the domestic
market. These results were in line with the data from the 2009 public health nutrition
environment survey in kindergartens, according to which the salt content of daily
meals provided by the public catering service in Hungarian kindergartens on average
is 6,9 g, almost three times higher than the recommended amount for the age group
in question.
Awareness raising campaign
The target groups and the messages of the awareness raising campaign were
identified based on survey results conducted. The survey was part of OTÁP2009
where knowledge on the relationship between salt intake and certain diseases and
knowledge on the main sources of salt intake were assessed. 83% of the population
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knew that there is a relationship between salt intake and certain diseases, but only
half of the adult population knew about the relation between excess salt intake and
high blood pressure. Half of the adult population believed that adding salt at home is
the main source of salt intake; only 30% indicated processed food. Therefore in the
campaign we raised awareness about that high salt intake causes high blood
pressure, heart attack and stroke, and what the people can take for lowering their
salt intake. We also put emphasis on informed costumer behavior, on the
recommended daily salt intake and the relation between salt and natrium content.
The image of the campaign came from the „STOP Salt Figure” and the „Do not be
salt up!” slogan that appeared in all our communication materials. There were
altogether 5000 copies of big size flyers, 500 000 copies of small flyers, 10 000
refrigerator magnets, 4 molinos, 20 T-shirts, 700 information leaflets for dining
tables.
We have used many different communication channels toward the population taking
into account cost effectiveness. In terms of electronic media, we have started a
website www.stopso.eu with the aim to supply the population and professionals with
timely and reliable information. In this website you can choose from topics such as
facts, how to lower your salt intake, Stop Salt National Salt Reduction Program, Stop
Salt Campaign, food industry, etc. During the time of the campaign there were
16 220 visitors to this website.
We used other forms of the electronic media, the campaign messages were included
in different news and thematic portals such as origo.hu or mindmegette.hu, which
are the biggest news and gastronomic portals. In addition to paid banners there
were smaller news and information items from the campaign as well. In the written
media we have selected papers with the biggest sold copies such as Metropol,
Sunday Blikk, this way the campaign messages could reach 1,5 million people.
Approximately 1,6 million people could hear the campaign’s radio spot 10 times in
the morning show in one of the most popular national radio channel Kossuth Radio,
while the Fortuna Radio in the South-Transdanubia disseminated our 30 second
spots 120 times. Many free TV opportunities were also used to convey the campaign
messages. The main messages of the campaign appeared for one month on the
busiest tram line in the capital city Budapest. 2500 flyers and 250 000 information
sheets were distributed to every pharmacy of the country. We disseminated the
campaign flyers to the screening camion of the European National Healthcare
Program.
In addition to this, the Institute of Food and Nutrition Science took part with the
campaign in 8 health days organized by the National Public Health and Chief Medical
Officer’s Service in the city of Budapest and Pest county. The campaign flyers were
also distributed to general practitioners’ offices, hospitals, local governments, public
caterers, child welfare institutions, leisure time and community centers, elderly
homes, school camps, etc. During summer 2010, the Salt Reduction Programme was
promoted in more than 65 national and local events reaching a wide range of the
population.
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Involvement of key stakeholders and partnership building
With the leadership of the Ministry of Health, in February 2010 a program launching
meeting took place with the participation of the representatives of the food industry,
public caterers, other ministries, civil-, health and consumer protection organizations,
health and health care professional institutes, altogether 42 participants. During and
after the meeting, there were offers for cooperation some of which have been
realized in an official manner later on (e.g. a public caterer company.)
With the food industry we held many discussions, during which the possibility of
using the Stop Salt logo on certain food products arose. Therefore the Institute in
line with the EU and national regulations the conditions of using the logo and we
launched a patterning process.
Since our previous studies on public health nutrition in schools and kindergartens
showed that in public catering salt and salt containing artificial flavoring are
frequently used together, one of our target partnership was the public catering
companies.
We had a very good working partnership and collaboration with professional
organizations such as the Hungarian Hypertonia Association, National Heart
Foundation, etc. These organizations promoted the Stop Salt Programme and
distributed the campaign materials on their own events. The Stop Salt Programme
also took part in the Hungarian Cardiovascular Consensus Conference. In addition,
we published several articles in domestic professional journals. As to international
events, upon the invitation of the WHO and the Food Standard Agency, we held a
presentation about the Hungarian Salt Reduction Programme on the event titled
WHO/FSA Technical Meeting on Creating an Enabling Environment for Populationbased Salt Reduction Strategies in July 2010.
Salt intake studies in Hungary
In the past decades, Hungarian population salt intake data was collected from
national nutrition surveys (National Institute for Food and Nutrition Science 1985-88,
1992-94, 2003-2004), based on which salt intake showed an almost unchanging level
of 14-16 g/day. Hungary participated in the INTERSALT Study in the 1980s,
organized by WHO in 52 centers from 30 countries. During this study, 24-hour urine
collection was the basis for assessing salt intake. There is no other domestic data
regarding salt intake. According to the EU framework program, the gold standard of
assessing salt intake is the 24 hour urine collection. The National Institute for Food
and Nutrition Science also opted for conducting this study in collaboration with the
National Institute for Primary Care. Six general practitioners helped in the urine
collection. Our institute identified the selection criteria of subjects and developed a
short questionnaire. The participating study subject also completed a 3-day dietary
record. We planned a sample of 200 people. This study is ongoing, results will be
published soon. National representative data on salt intake will come from the
National Diet and Nutritional Status survey conducted in 2009.
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Some publications in domestic journals related to the Hungarian Salt
Reduction Programme:
Martos É.: Európai összefogás a lakosság sóbevitelének csökkentése érdekében –
Nemzeti Sócsökkentı Program. Metabolizmus. 2010. VIII évf. suppl A: 23-24.
Martos É., Lugasi A., Bakacs M., Papp I., Kovács V.A.: STOP- SÓ Nemzeti
Sócsökkentı Program. Népegészségügy 2010; 2: 101-106.
Kiss I.: Nemzeti Sócsökkentı Program: STOP SÓ. MOTESZ Magazin 2010; 1:46–48.
Kiss I.: Élvezetes és láthatatlan kockázat: a só. A Magyar Hypertonia Társaság
szerepe a Nemzeti Sócsökkentı Programban: STOP SÓ. Hypertonia és
Nephrologia 2010; 14 (1): 6-8.
Baltás Lászlóné: Sócsökkentést határozott el az Európai Unió. A pékeknek komoly
feladatuk lesz. Sütıiparosok, pékek. 2009. LVI, 5.
Új szelek a közétkeztetésben. Beszámoló a KÖZSZÖV Szakmai Napról. PINCÉR. XV.
2010. május
Egészségkönyv. Magyarország átfogó egészségvédelmi szőrıprogramja, 2010-2010.
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