Salt intake reduction strategies in the Eastern Mediterranean Region

Background: The high burden of noncommunicable diseases [NCDs], particularly cardiovascular diseases [CVDs], in countries of the Eastern Mediterranean Region requires an immediate public health attention. The World Health Organization [WHO] has recommended salt reduction as a “best buy”, recognizing it as one of the most cost–effective approaches in preventing NCDs and reducing CVDs and medical costs.

Aims: In the context of the global target to reduce salt intake by 30% by 2025, the objective of this review is to present an up-to-date overview of the current salt reduction initiatives in the Region by highlighting regional and national policies, strategies, and activities that aim at characterizing and/or reducing the intakes of dietary salt.

Methods: This review details the WHO policies and strategies which address salt reduction in the WHO Eastern Mediterranean Region.

Results: The high intake levels of sodium in the countries of the Region are emphasized. The policies and strategies in place to address this situation are described, however, there is a need for more data on intake levels.

Conclusions: There are a number of salt reduction initiatives currently being undertaken in the countries of the Region. The WHO should continue to play a key role in providing evidence-based tools for the planning, implementation, and surveillance of national salt reduction initiatives

Assessment of salt concentration in bread commonly consumed in the Eastern Mediterranean Region

Background: Hypertension is the most important cardiovascular risk factor in the World Health Organization [WHO] Eastern Mediterranean Region. Excessive salt and sodium intake is directly related to hypertension, and its reduction is a priority of WHO. Bread is the leading staple food in the Region; therefore, reducing the amount of salt added to bread could be an effective measure for reducing salt intake. Aim: The study sought to determine the levels of sodium and salt in locally produced staple bread from 8 countries in the Region. Methods: Bread samples were collected randomly from bakeries located in the capital cities of the selected countries. The samples were analysed for sodium content using atomic absorption spectroscopy. Results: The mean salt content of breads varied from 4.28 g/kg in Jordan to 12.41 g/kg in Tunisia. The mean salt and sodium content in bread for all countries was 7.63 [SD 3.12] and 3.0 [SD 1.23] g/kg, respectively. The contribution of bread to daily salt intake varied considerably between countries, ranging from 1.3 g [12.5%] in Jordan to 3.7 g [33.5%] in Tunisia. Conclusion: Interventions to reduce population salt intake should target reduction of salt in bread in all countries. The amount of salt added to bread should be standardized and relevant legislation developed to guide bakers. Setting an upper limit for salt content in flat bread [pita or Arabic bread] at 0.5% is strongly recommended. However, salt levels at

Implementation of the International Code of Marketing of Breastmilk Substitutes in the Eastern Mediterranean Region

Background: Optimal breastfeeding practices and appropriate complementary feeding improve child health, survival and development. The countries of the Eastern Mediterranean Region have made significant strides in formulation and implementation of legislation to protect and promote breastfeeding based on The International Code of Marketing of Breast-milk Substitutes [the Code] and subsequent relevant World Health Assembly resolutions. Aim: To assess the implementation of the Code in the Region. Methods: Assessment was conducted by the World Health Organization [WHO] Regional Office for the Eastern Mediterranean using a WHO standard questionnaire. Results: Seventeen countries in the Region have enacted legislation to protect breastfeeding. Only 6 countries have comprehensive legislation or other legal measures reflecting all or most provisions of the Code; 4 countries have legal measures incorporating many provisions of the Code; 7 countries have legal measures that contain a few provisions of the Code; 4 countries are currently studying the issue; and only 1 country has no measures in place. Further analysis of the legislation found that the text of articles in the laws fully reflected the Code articles in only 6 countries. Conclusion: Most countries need to revisit and amend existing national legislation to implement fully the Code and relevant World Health Assembly resolutions, supported by systematic monitoring and reporting

Review of the nutrition situation in the Eastern Mediterranean Region

This situation analysis for the World Health Organization Eastern Mediterranean Region focuses on specific nutrition indicators, namely low birth weight, exclusive breastfeeding, under- and overnutrition [anthropometric indicators] and anaemia. The regional average prevalence of low birth weight and exclusive breastfeeding was estimated at 19.31% and 29.3%, respectively. Stunting, wasting and underweight had an average prevalence of 28%, 8.69% and 18%, respectively. Afghanistan, Djibouti, Pakistan, Sudan and Yemen had the highest burden of stunting [> 30%]. Prevalence of anaemia ranged from 7.4% to 88% in children aged < 5 years and from 19.9% to 63% in women of childbearing age. Of concern is the increasing trend in overweight and obesity among adults and children. Average prevalence of overweight and obesity was 27% and 24% in adults and 16.5% and 4.8% in school-aged children, respectively. The highest levels of obesity were reported from Bahrain, Kuwait, Qatar and the United Arab Emirates. This review highlights the double burden of malnutrition in countries of the Region and calls for the prioritization of policies aimed at improving the population's nutritional status