Activities and plans at WHO Activities and plans at WHO HeadquartersHeadquarters

Activities and plans at WHO Activities and plans at WHO HeadquartersHeadquarters

Godfrey C Xuereb Team Leader

Population-based Prevention TeamSPP Unit

Department of Chronic Diseases and Health Promotion

Population Salt Reduction StrategiesPopulation Salt Reduction StrategiesPopulation Salt Reduction StrategiesPopulation Salt Reduction Strategies

Improving public health through the optimal intake of iodine and sodium 31 March – 1 April 2011

Six objectives:

1. Raising the priority accorded to non-communicable diseases in development work at global and national levels

2. Establishing and strengthening national policies and programmes

3. Reducing and preventing risk factors

4. Prioritizing research on prevention and health care

5. Strengthening partnerships

6. Monitoring NCD trends and assessing progress made at country level

Under each of the six objectives, there are sets of actions for member states, WHO Secretariat and international partners

MandateMandateMandateMandate

3 .Reducing and preventing risk factors

Improving public health through the optimal intake of iodine and sodium 31 March – 1 April 2011

Population Salt Reduction StrategiesPopulation Salt Reduction Strategies

Creating enabling

environment

Consumer education

Product Reformulation

Policy makersPrivate sector

NGOsAcademia

WH

AT

HO

WW

HO

London, England30 June – 1, 2 July 2010

Iodine fortification

Reduction of salt intakeFood Composition Data

Sodium consumption

Calgary, Canada18-20 October 2010

Policy makersPrivate sector

NGOsAcademia

Policy makersNGOs

AcademiaUN Agencies

Date and location to be determined

1 Evaluation and

monitoring

2 Salt:vehicle for fortification

3

Improving public health through the optimal intake of iodine and sodium 31 March – 1 April 2011

Platform 1& 2Platform 1& 2

Platform 1 - Organized jointly with UK FSA– Information Exchange Forum with the Private Sector and

Nongovernmental Organizations on population-based salt reduction strategies

– Technical Meeting on creating an enabling environment for population-based salt reduction strategies

Platform 2 - Organized jointly with Government of Canada– Information Exchange Forum with the Private Sector and

Nongovernmental Organizations on Strategies to Monitor and on Strategies to Monitor and Evaluate Population Sodium Consumption and Sources of Sodium in Evaluate Population Sodium Consumption and Sources of Sodium in the Dietthe Diet

– Technical Meeting on Strategies to Monitor and Evaluate Population Strategies to Monitor and Evaluate Population Sodium Consumption and Sources of Sodium in the DietSodium Consumption and Sources of Sodium in the Diet

Improving public health through the optimal intake of iodine and sodium 31 March – 1 April 2011

Outcomes of three PlatformsOutcomes of three Platforms

Platform 1 – Reducing salt intake: a practical tool for Member States

– Practical approach for implementing an education and public awareness campaign

– Practical approach for engaging food and meal producers and distributors

Platform 2 – Global framework for effective M&E of sodium reduction strategies

– Monitoring sodium intakes– Monitoring sources of sodium– Monitoring consumer knowledge and behaviour

Platform 3 – Salt Reduction and Iodine Fortification – making the two strategies work together

Nutrition Guidance Expert Advisory Nutrition Guidance Expert Advisory Group (NUGAG)Group (NUGAG)

Nutrition Guidance Expert Advisory Nutrition Guidance Expert Advisory Group (NUGAG)Group (NUGAG)

Improving public health through the optimal intake of iodine and sodium 31 March – 1 April 2011

WHO Guidelines on Sodium Consumption for the General Population

WHO Guidelines on Sodium Consumption for the General Population

Current guideline < 2g Na (5g salt) / d to prevent CVD

Evidence suggests lower Na intake (1.2 g/day) may confer additional health benefits

WHO guideline being reviewed and updated

Priority questions for systematic reviews – What is the effect of reducing sodium intake to 1.2 g/d vs. 2.0 g/d on blood

pressure and incidence of stroke, coronary heart disease, and cardiovascular disease in hypertensive and non-hypertensive adults?

– What is the effect of reducing sodium intake to the equivalent of 2.0 g/d (based on caloric intake) vs. > 2.0 g/d on blood pressure in children?

Systematic reviews being undertaken currently

Evidence to be considered by NUGAG and recommendations drafted at Nov 2011 meeting

Improving public health through the optimal intake of iodine and sodium 31 March – 1 April 2011

WHO Guidelines on Potassium Consumption for the General Population

WHO Guidelines on Potassium Consumption for the General Population

Currently no WHO guideline on potassium consumption

Evidence suggests health benefits

WHO guideline to be generated at request of Codex

Priority questions for systematic reviews – What is the effect of consuming > 90 mmole/d potassium vs < 90 mmole/d on

blood pressure and incidence of stroke, coronary heart disease, and cardiovascular disease in hypertensive and non-hypertensive adults?

Systematic reviews being undertaken

Evidence to be considered by NUGAG and recommendations drafted at Nov 2011 meeting

Improving public health through the optimal intake of iodine and sodium 31 March – 1 April 2011

WHO Guidelines on Fortification of Salt with Iodine

WHO Guidelines on Fortification of Salt with Iodine

Priority question for systematic review

– Is salt iodization safe and effective for reducing IDD?

Updating Cochrane systematic review from 2002

Outcomes: goiter, hypothyroidism, iodine intake, cretinism, cognitive function, adverse events

Some subgroups of interest to be examined:

– Age (<59 months, 5-12 yrs, Women of Reproductive Age, pregnant women)

– Population salt consumption (<5, 5-9.9, 10-14.9, >=15g/d)

– Iodine consumption based on urinary iodine excretion

– Concentration of iodine in salt (<20, 20-40, >40ppm)

– Availability of iodized salt source (HH only, processed foods only, USI, unknown)

Systematic review near completion

To be considered at Nov 2011 NUGAG meeting

http://www.who.int/dietphysicalactivity/reducingsalt/en/index.htmlhttp://www.who.int/dietphysicalactivity/reducingsalt/en/index.html

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http://www.who.int/dietphysicalactivity/reducingsalt/en/index.htmlhttp://www.who.int/dietphysicalactivity/reducingsalt/en/index.html

http://www.who.int/nutrition/topics/http://www.who.int/nutrition/topics/guidelines_nhd_callforpubliccomments/en/index.htmlguidelines_nhd_callforpubliccomments/en/index.html

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