Population-based salt intake survey to support the national salt reduction programme for Malaysia

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Cardiovascular disease including strokes, heart attacks and heart failure, is the leading cause of death and disability in Malaysia and worldwide. Hypertension is an important risk factor for cardiovascular disease, responsible for over 60% of strokes and almost 50% of coronary heart disease. High salt intake is the major cause of hypertension, accounting for about half of the disease burden attributable to blood pressure. Reducing salt intake to the World Health Organisation recommended level of 5 gram/day could prevent approximately 1.65 million cardiovascular deaths per year globally. There is also evidence that a reduction in salt intake may have many other beneficial effects on health. For example, a lower salt intake is associated with a reduced risk of stomach cancer, related to a lower risk of obesity directly or indirectly through a reduction in soft drink consumption, and associated with a reduced risk of kidney diseases and osteoporosis. Indeed, salt reduction is one of the most cost-effective public health policies to reduce non-communicable diseases. The World Health Organisation has recommended salt reduction as one of the top three priority actions to tackle the global non-communicable disease crisis. In Malaysia, the prevalence of hypertension is high with approximately one third of the adult population having hypertension in 2011. This figure continues to rise. It is estimated that 7.6 million adults would have hypertension by 2020. Salt intake in Malaysia is likely to be very high. The Ministry of Health Malaysia started a salt reduction initiative in 2010. However, the progress has been very slow and there is still lack of key contemporary data upon which to formulate policy and engage key stakeholders. We propose to carry out a cross-sectional study to determine the level of salt intake among the Malaysian adult population using the gold standard method, i.e. 24h urine collection. Additionally, we will assess the main sources of salt in the diet using food frequency questionnaire, and assess the knowledge, attitude and practice towards dietary salt among the Malaysian adult population by completing a standardised questionnaire.Our study will provide valuable data which are urgently needed for the development and effective implementation of a national salt reduction programme in Malaysia. This will lower salt intake across the whole population and thereby prevent many thousands of unnecessary deaths from strokes, heart attacks and heart failure each year, and also lead to major cost-savings to individuals, their families and the health services. Although our study will be carried out in Malaysia, the research findings and the evidence-based salt reduction strategy developed in our study could potentially be generalisable to many other developing countries, particularly South East Asia. A reduction in salt intake, even by a small amount, across the whole population around the world will have enormous benefits in reducing the huge burden attributable to chronic non-communicable diseases.