The State of Salt

A study based on the nutritional information provided by leading fast food chains across the world has shown that there is a considerable variation in salt content of the fast food products between categories, countries and also brands. The study was published in the Canadian Medical Association Journal (CMAJ) in April.

The study included seven different categories of fast foods from six leading fast food chains in Australia, Canada, France, New Zealand, the UK and the US and it found that the products sold in the UK had less salt in almost all categories than the overall average. In UK, where food regulators had made salt reduction a priority, several categories of fast food had about 15 percent less sodium than in the United States.

The results are significant considering that many companies have quoted technical problems in reformulation of products and salt reduction in them.  “Salt content in fast foods from different transnational chains differs from country to country, which means that technically there is scope for reducing the salt content in these food items. Strict regulations from government on food labeling can help solve this issue,” said Anoop Misra, chairman, National Diabetes, Obesity and Cholesterol foundation.

The researchers collected data on salt contents of products from the official websites of the companies and performed statistical analysis. Data was collected on a total of 2124 fast food products categorized under savoury breakfast items (breakfast burgers, rolls, breakfast sandwiches and hash browns), burgers, chicken products, pizza, salads, sandwiches and french fries from Burger King (known as Hungry Jack’s in Australia), Domino’s, KFC, McDonald’s, Pizza Hut and Subway.


There was considerable variation in salt content of the products both between and within the product categories as well as between countries. The same products of different brands also had different salt contents (see Box: Salt Variations).

“What we wanted to highlight the most was that even in very similar products there was great variability in salt content. It is of course expected that there would be differences between different types of products, but less expected that there would be such large differences between similar products” said Elizabeth Dunford, a research officer with the Australian Division of World Action on Salt and Health, who led the research.

The variability of salt content was measured both per 100 g as well as well as per serving. The variation per serving was found much greater than that of the salt content per 100 g. This, researchers explain was due to the non-uniformities in the serving sizes among product categories, countries and brands. The least serving size was 65 g for a Hawaiian pizza by Domino’s in Australia, which was about one sixth of the largest serving size of 373 g for Double Whopper from Burger King in Canada. Large serving sizes also meant a lot of salt per serving. There are variation in serving sizes as well- large serving sizes mean high salt content for instance some chicken products and burgers had more than 6 g of salt per serving; some salads had more than 7 g per serving. 

The saltiest of the sandwiches had around 8 g of salt per serving while the saltiest of the pizzas had more than 10 g of salt. Both of these would exceed the daily requirement of salt in just one meal. The WHO has set target to reduce the per capita salt consumption to five grams per day. The National Institute of Nutrition (NIN) has recommended a limit of six grams per day per person for salt.

But the study has its limitations.  The study was based entirely on the information provided by the websites of the companies. This, as a recent study by the Delhi based NGO Centre for Science and Environment (CSE) found, could be misleading. In a lab study of the salt, sugar and fat contents of junk foods available in India, CSE found that the levels varied considerably from the information provided by the companies on either the labels or the websites. However, the salt contents of the junk food products tested by CSE were also found to vary in a similar manner. The least salt content was found in Nirula’s French fries which had 0.2 g salt per 100 g of the food. The highest salt content was found in Maggi Masala noodles which had 4.2 g salt per 100g.

The non-packaged junk foods in India give nutrition information on their websites, but there clearly is double standard in play. McDonalds, for instance, gives information on 22 nutritional attributes on its US website. On the other hand, McDonald’s website for India provides information only on six nutritional attributes. But at least provides information on portion sizes in India. Other companies do not even do that.

Pizza Hut’s website for India is a case in point. The company’s website in the US provides 12 nutritional attributes of the product, including the serving size, and even salt. The Indian website provides only six attributes in the dining menu; it mentions salt but not the serving size. KFC’s website in US also provides the information on 12 nutritional attributes including the serving size but its Indian counterpart gives only four nutritional information.

“This proves that health is not in their radar. They are making products to make it tasty and saleable. Moreover there are no regulations for salt in countries and companies can get away with unregulated levels of salt” said Chandra Bhushan, the deputy director general of CSE, about the study.

High salt consumption is linked with the increased risks of hypertension and heart diseases. The human body requires a very small amount of sodium, of which salt is the main source, along with potassium to maintain a proper fluid balance in and around cells. However, most of the people around the world generally eat a lot more salt than they require. 

For instance, in India the salt consumption in India varies between 5 to 30 g per person per day according to NIN. The average salt consumption in US for a person more than 2 years in age around 8.6 grams per day according to the Centers for Disease Control and Prevention (CDC). Similarly the average salt consumption in Australia is 10 g per day for men and 7 g per day for women according to the Australian Division of World Action on Salt and Health (AWASH).

The strategies adopted by different countries to reduce salt consumption are mostly non regulatory in nature. These strategies have been based mainly on setting time bound targets of salt reduction, spreading awareness about it among people and creating pressure on food companies to reduce the salt levels in their products.
 
Processed food contributes majority of dietary salt intake in many countries. For instance, processed foods contribute 77 % of the dietary salt in US according to American Heart Association. Center for Science in the Public Interest (CSPI), a non profit policy and advocacy group, have written to USFDA urging them to implement mandatory sodium reduction. CSPIs executive director Michael F Jacobson states that over 100,000 lives could be saved annually if sodium levels in packaged and restaurant foods were halved.  According to CSPI, direct medical costs would be cut by about $18 billion per year if sodium consumption were reduced from 3,400 milligrams per day to 2,300 mg per day; $28 billion could be saved if consumption were further reduced to 1,500 mg per day.
 
“There is virtually nothing else the FDA could do to improve America’s food supply that would provide a greater benefit to public health than to reduce sodium levels,” Jacobson stated in a press release.  “We urge the FDA to issue strong rules that will protect Americans’ health.”

In Canada too, the contribution of processed food to dietary salt is 77% according to Statistics Canada while according to AWASH 75% of the dietary salt in Australia comes from processed food. Therefore, the focus of the salt reduction programmes in most of the countries has mainly been on the processed food. UK and Finland have had most successful programmes on salt reduction. In UK a salt reduction campaign launched by the Food Standards Agency in 2004 saw a 0.9 g per day reduction in salt consumption. The North Karelia project launched in Finland over 30 years ago reduced average salt consumption in country by one third.

The study is important especially that the share of fast foods in our daily meals is increasing at a very fast rate. In a survey in 2011 by the Associated Chamber of Commerce and Industries (ASSOCHAM) in the major cities of India 86% of the households preferred to have instant food. Eighty five percent of the parents who had children below five years had ready to eat meals 7-10 times a month.
 
A major portion of the dietary salt has been coming from fast foods in industrialized countries. The trend is gaining pace in developing countries. According to a report by RNCOS, a marketing research firm based in Delhi, the fast food industry in India is expected to grow at a rate of 30-35% between 2011 and 2014.

“There is strong need to generate awareness among people regarding harmful effects of high sodium intake. Public campaigns using audio-visual media should be used to generate awareness and this should be coupled with stringent food labeling. The label is the first point of contact between a consumer and the food product. It is used to identify one product over the other and to make a decision,” said Seema Gulati, chief project officer, Diabetes Foundation (India), a non profit research and advocacy group on diabetes, obesity and heart diseases.