Restrict or eliminate choice ^a

Limitations of salt content in foods

• The common European Union Framework on voluntary national salt initiatives set a benchmark of a minimum of 16% salt reduction over 4 years (2008-2012) for all food products, also encompassing salt consumed in restaurants and catering. The reduction in salt content should be progressive.
• Examples of legislative approaches in EU countries: in Belgium maximum level of 2% salt on dry matter of bread (not applied to imported bread); in Portugal and Croatia maximum level of salt in bread is 1.4 g salt/100 g.

• Legislation on mandatory maximum levels of sodium in meat products, breads, soups, seasoning mixes, and tinned food, also applicable to salt levels in restaurant dishes. Producers and importers not meeting the requirements may be fined.

School food policies

• Various European countries have school food policies that address salt reduction or restrict the use of salt (in food preparation and/or at the table), savoury snacks and marketing of products high in salt.
  • In France, the regulation on nutritional quality of school meals includes restrictions on salt ( Decree n° 2011-1227 ).
  • In Italy, the National guidelines on nutritional quality of school meals focuses also on salt reduction ( IMH 2010 (pdf) ).
  • In Romania, legislation sets maximum amounts for salt (1.5 g salt or 0.6 g sodium per 100 g) in food sold in schools and pre-schools.

• Products distributed under the school fruit, vegetables and milk scheme shall not contain added salt.

Guide choice through (dis)incentives^a

Taxes

• Public Health Product Tax is applied on products high in salt, including salty snacks (>1 g/100 g), condiments (>5 g/100 g), and flavourings (>15 g/100g).

Enable or guide choice through changing defaults^a

Food reformulation

• The 'Salt List' aims to inspire producers to lower salt content in all products for the benefit of public health. The list, compiled by a working group under the Danish Salt Partnership (public-private partnership), consists of 15 target food categories and 77 subcategories, and is part of the Danish salt reduction strategy.

• Salt Reduction Programme initiated by the food safety authority aims to voluntarily reduce salt content in processed foods. Companies and trade associations register within the programme and report yearly on undertakings and achievements.

• Voluntary reduction of salt (by 25%) in meat products introduced by the largest meat industries, under the Strategic Plan for reducing the excessive intake of kitchen salt in Republic of Croatia, 2014 – 2019.

• Salt reduction strategy to reduce (≥10%) salt content in bread and other processed foods through voluntary agreements signed between the Ministry of Health and the main National Associations of Bakers and other associations of food Industry.

• An agreement (collaborative protocol) has been signed between the Health Ministry and the bread industry to further reduce salt content in bread to 1 g/100 g by 2021 as part of the national strategy to promote healthy diet ( Diário da República ) . The agreed approach is to reduce by 0.1 g per year salt content per 100g of bread until 2020 (current legal limit is 1.4 g/100 g). To encourage this change, the Ministry of Health has developed a label of excellence that is awarded to the bakeries that are already adhering to the 1 g/100 g limit ( SNS (pdf) ) .

• The UK salt reduction sets targets for industry to reduce the salt content. To date, there have been four sets of target published (2006, 2009, 2011 and 2014). The targets specify specific salt or sodium levels to be met in 80 food categories and subcategories, including various meat, cereal, bread, cheese pizza, sandwiches and snack products.
• '…businesses can say they have met the target(s) for an individual sub-category if 95% of products or volume sales meet the targets and if efforts have been made to reduce salt in the remaining 5% of products or volume sales to a minimum'.

• Mandatory and voluntary reformulation through 'Less Salt, More Life' initiative. Voluntary agreements negotiated and signed with food industry (food manufacturers and retailers).

• A salt reduction strategy engaged food industry to voluntarily reduce salt content in bread and cheese. One company produces 80% of bread and reduced 10% of the salt content of almost all products during first three months. The Ministry of Health emphasized educating companies on methods and benefits of salt reduction and the importance of private sector in population-wide salt reduction.

Marketing restrictions

• Various mandatory (via legislation) or voluntary (via industry self-regulation) policies are in place in the EU to restrict food marketing of foods that are high in sugar, salt and fats to children; a major industry self-regulation effort is the EU Pledge.  See Food and Non-alcoholic Beverages Marketing to Children and Adolescents in this series.

• All television advertising for processed foods containing added salt must be accompanied by a message such as 'For your health, eat at least five fruits and vegetables per day' or 'For your health, avoid eating too many foods that are high in fat, sugar or salt'.

• Legislation on foods high in salt (>0.3 g/100 g or ml) including restrictions on advertising at children less than 16 years (e.g. not using gifts or other benefits to encourage purchase, not using characters familiar to children). For advertising foods high in salt, a warning 'High in sodium: avoid excessive consumption' must be used.

Retail initiatives

• Shop Healthy in New York City in the US works with communities aiming to increase access to healthy food especially in areas with high rates of obesity. Department of Health staff works with shop owners to sell more low-salt products.

Provide information^a

Labelling legislation

• Regulation 1169/2011 on food information to consumers requires mandatory nutrition declaration for the amount of salt in g/100g.
• Regulation 1924/2006 on nutrition and health claims made on foods states that permitted claims for salt are low sodium/salt, very low sodium/salt, sodium-free or salt-free, reduced salt and no added salt. See paragraph 3 Labelling in the EU.

• Compulsory use of warning labels on high-salt food in all the food categories that substantially contribute to the salt intake. Thresholds for the label as percentage by weight are e.g. more than 1.1% of salt in bread, 2.0% in sausages, 2.2% in cold meat cuts, 2.0% in fish products, 1.4% in cheese, 1.2% in ready meals, 1.4% in breakfast cereals or crisp bread. Also applied to unpackaged foods, in which case the warning sign must be communicated at the point of purchase.

• Foods that exceed 400 mg/100 g or 100 mg/100 ml of sodium will have a front of package warning message stating 'HIGH IN SODIUM'.

• Health claims are not permitted on foods that contain, per reference amount customarily consumed or per labelling serving size (exceptions apply) more than a set amount of 'disqualifying nutrient levels'. Among these the sodium threshold is 480 mg.

• Chain restaurants in New York are required to put a warning label (salt shaker inside a triangle) on menus and menu boards if dishes contain 2,300 mg sodium or more. The meaning of the symbol must be presented conspicuously at the point of purchase.

Voluntary labelling

• The Keyhole logo used in many northern countries is based on a nutrient profile model and aims to identify healthier packaged food choices within a food category, and to stimulate food manufacturers to reformulate and develop healthier products. Salt content is one of the nutrient criteria, and thresholds depend on the product category.

• Products in line with the salt targets issued by the Danish Veterinary and Food Administration and the Danish Salt Partnership are able to make statements such as 'in line with the Government recommended salt targets'.

• The French Nutri-Score front-of-pack labelling scheme discourages high sodium contents by assigning negative points depending on the sodium content per 100 g of food product.

• The Traffic Light front-of-pack voluntary labelling scheme, proposed by the UK Food Standards Agency, aims to assist consumers in identifying healthier food choices. It uses colour coding related to low, medium or high content of selected nutrients in foods and drinks. For total salt content in foods, the thresholds are (per 100g): green/low: ≤0.3 g, medium/amber: >0.3 to ≤1.5 g, high/red: >1.5 g. For salt content in drinks, the thresholds are (per 100 ml): green/low: ≤0.3 g , medium/amber: >0.3 to ≤0.75 g, high/red: >0.75 g.

• 'The voluntary [Health Star Rating] system is a front-of-pack labelling system that rates the overall nutritional profile of packaged food and assigns it a rating from ½ a star to 5 stars. It provides a quick, easy, standard way to compare similar packaged foods. The more stars, the healthier the choice.'

• Voluntary menu labelling for fast food chain restaurants. Nutrients are displayed per portion and include salt.

Food-based dietary guidelines

• Most EU countries have national food based dietary guidelines that recommend limiting the intake of salt.

Public health campaign

• One aim of the EU Framework for National Salt Initiatives is to raise public awareness. It supports reformulation of foods.

• The UK's Food Standards Agency (FSA) raised awareness of salt consumption and how to reduce it using websites, TV, posters and printed materials, articles in women's journals and newspapers. They ran a four-phase campaign by educating the people on health concerns, encouraging reading food labels and not consuming more than 6 g of salt per day, focusing on high salt content foods and choosing low-salt products instead.

Monitor^a

• An aim of the EU Framework for National Salt Initiatives is to monitor activities on reformulation, public awareness, and salt intake.

• In Denmark, monitoring of consumer salt intake measurements were performed in 1999, 2006, 2010, 2014 and 2016/2017.  Recently, the Research Centre for Prevention and Health has developed and validated a method by which it is possible to estimate the salt intake in a Caucasian population using single spot urine. This method will be used to monitor the progress of the Danish strategy to reduce salt intake on a population level.

• As part of the national salt reduction programme industry was asked to gradually decrease sodium levels. The levels of sodium and potassium across ten categories of processed foods have been monitored to support the salt reduction programme and provide information about industry commitments.

• In Italy, periodic monitoring of daily average dietary intake of sodium, potassium and iodine per capita is being performed (by 24-hour urine collection) in representative samples of Italian population. This monitoring is also used for the evaluation of actions related to excessive salt intake reduction in the Italian National Program “Gaining Health” ( Salute 2007 (pdf) ) and National Prevention Plan 2014-2018 ( Salute 2014 (pdf) ).

• Monitoring the salt content in foods and publishing the data to encourage the food industry to reformulate foods to contain less salt. The target levels for salt were set for different categories of food products, and they were revised and reset every two years.