The World Health Organization has recommended that all member states, including India, reduce mean population salt consumption by 30% to prevent non-communicable diseases. The development and implementation of a national salt reduction program will be informed by knowledge of population salt.Design and Method:
Searches were undertaken in MEDLINE, EMBASE, CINAHL and the Cochrane Reviews databases up to November 2015 for studies that reported mean or median dietary salt intake in Indian adults. Random effects meta-analysis was used to obtain summary estimates and the I2 statistic to determine differences between studies beyond chance.Results:
There were 1201 abstracts identified, 21 studies were included: 18 cross-sectional surveys (n = 225,024), 2 RCTs (n = 255); and 1 case control study (n = 270). Data spanned 1986 to 2014 and reported mean salt consumption levels between 4.47 and 42.3 g/day. With an extreme outlier excluded, overall mean weighted salt intake was 10.85 g/day (95% CI 10.57 to 10.93). There was significant heterogeneity in findings across the 5 studies that estimated salt intake from 24-hr urine samples (11.29 g/day, 95 % CI 10.89 to 11.68 g/day), 4 using 24-hr dietary recall surveys (7.99 g/day, 95% CI 7.97 to 7.99), 3 using food frequency questionnaires (8.91 g/day, 95% CI 8.87 to 8.95), 5 using food diaries (10.36 g/day, 95% CI 10.29 to 10.43), 2 using salt weighing (11.22 g/day, 95% CI 11.19 to 11.24) and 1 food testing (6 g/day) (X2 = 1878.63, p-homogeneity ≤0.001). Intake was higher in rural vs. urban populations (9.52 vs 9.05 g/day respectively) (X2 = 6.454, P ≤ 0.011) but there was no change in intake apparent over time (p trend = 0.08).Conclusions:
The available data leave considerable uncertainty about exact salt consumption levels in India but there is little doubt that mean Indian intake exceeds the WHO recommended 5 g/day target.