University of Warwick

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WHO Collaborating Centre for Nutrition who_logo.gif

In September 2008, the Clinical Sciences Research Institute of Warwick Medical School was designated for four years as a WHO Collaborating Centre for Nutrition to work on the following. The terms of reference of the WHO Collaborating Centre are presented as bullet points and briefly describe the scope of the activities that the institution performs as a WHO Collaborating Centre:

Operational support:

  • To compile and keep up-to-date national guidelines on salt reduction at population level in European countries.
  • To extend the search and cataloguing in countries worldwide.
  • To continue systematic reviews to inform policy makers and to monitor international progress.

Research:

  • To increase the research output in the following areas that are of interest to the WHO general framework:
    (a) quantitative monitoring of urinary sodium output;
    (b) analysis of trends in urinary output;
    (c) producing evidence of the effectiveness of implementation programmes.
  • To monitor the development of new policies for the reduction of salt intake.
  • To study how the development of new policies is influenced by research findings.
  • To explore issues of distribution and access to food items reduced in salt and socio-economic barriers to their use.
  • The Centre studies the potential impact of social and health inequalities on the implementation of nutritional policies for a reduction in salt intake and nutritional interventions targeted at low socio-economic groups.

Monitoring within the European Network:

  • To act as an integral partner in the development, implementation and monitoring of national programmes aiming at a reduction in salt intake.
  • To support monitoring and surveillance by providing centralized laboratory measurements of urinary sodium, potassium and creatinine obtained from random samples of participating populations.

Education, Training and Capacity Building:

  • To organize workshops and seminars aimed at the dissemination of information regarding methods, nutritional skills, policy issues and implementation tools for European participation.

2006 Forum and Technical Meeting

WHO organized a forum and a technical meeting on Reducing Salt Intake in Populations, from 5 to 7 October 2006 in Paris, France.

The Forum reviewed the current evidence base on a wide range of topics, including initiatives, policies and programmes aimed at reducing salt intake in the population, methods for measuring salt intake, main contributors to salt consumption and the impact of lowering salt intake on health care spending. Stakeholders involved in the development and implementation of salt reduction policies presented their activities and participated in the forum discussions.

During the technical meeting, which followed the forum, working groups discussed the rationale for recommendations on reducing salt intake, guiding principles for policy development and specific issues to consider at national level when planning an intervention on salt reduction. The WHO temporary advisers who participated in the technical meeting drafted a series of recommendations to different stakeholders on how to facilitate the reduction of salt intake at the population level with the long term objective of preventing chronic diseases.

Click here to download the document "Reducing salt intake in populations - Report of a WHO Forum and Technical Meeting"

Salt as a vehicle for fortification, Luxembourg 2007

As a follow-up to the forum and a technical meeting on "Reducing Salt Intake in Populations", held in Paris (France) in October 2006, WHO organized an Expert Consultation on "Salt as vehicle for fortification", which was held in Luxembourg in March 2007.

A report of this expert consultation was produced and can be downloaded here.

PAHO/WHO Regional Expert Group on Cardiovascular Disease Prevention through Dietary Salt Reduction

In 2009, the PAHO Director, Dr. Mirta Roses Periago, convened a two-year Regional Expert Group (EG) to lead and issue recommendations towards the PAHO initiativeCardiovascular Disease Prevention through Dietary Salt Reduction.

The Expert Group successfully completed the two years in October, 2011, culminating with the Second Meeting of the Expert Group and completion of the Final Report. The EG is enriched with new members, and will continue as the Technical Advisory Group (TAG) in the future.

Objectives of Initiative

The main objectives of initiative were to:

  • paho_salt.jpgexplore the current epidemiological situation regarding cardiovascular disease and its link to excessive salt consumption in the Americas;
  • review existing policies, interventions and programs aimed at reducing dietary salt and issue evidence-based recommendations for salt reduction in the Region;
  • review, discuss and agree with relevant partners’ adjustments necessary for use of salt as vehicle for micronutrient fortification;
  • foster public and private partnerships.

About the Expert Group

The Regional Expert Group of PAHO (EG) is a multi-faceted scientific and technical group formed by experts recognized worldwide in the fields of nutrition and cardiovascular disease.

The EG worked for a span of two years, from 2009 until 2011, and will continue its work as the Technical Advisory Group. PAHO served as the Secretariat for the initiative and worked with the chair, Dr. Norm Campbell, and the co- chairs, Drs. Rainford Wilks and Ana Beatriz Pinto de Almeida Vasconcellos (until 2011) and Patrica Jaime (during 2011), on a regular basis in order to report on progresses and to stimulate further actions.

To learn more about the EG, please click here.

Advances

Policy Statement

The Policy Statement provides countries with a roadmap for concerted action by governments, nongovernmental organizations (NGOs), and the food industry. It is currently available for open distribution and endorsement. To learn more about the Policy Statement, click here.

Advocacy Resources

Fact Sheets

Monitoring and Evaluation Resources

A Review of Methods to Determine the Main Sources of Salt in the Diet to determine the main sources of salt intake.

Protocol for detection of salt in 24 hour urine and position on the use of spot urine for monitoring

Liaison with Industry Products

Questionnaire of industry reformulation practices geared toward multinational food industries with markets in the Americas in order to learn about their effort to reduce salt in packaged foods

PAHO/WEF Statement of Rio de Janiero

Salt/Iodine Collaboration

White Paper

Final Report of Improving Public Health through the Optimal Intake of Iodine and Sodium Meeting

visit website here

Salt Experts Sub-group on Dietary Salt Surveillance (Mexico City and Cuernavaca, Mexico, 11-12 March 2010)

 PAHO Mexico

Dr R Correa-Rotter (Mexico), Dr D Ferrante (Argentina), Dr N Campbell (Canada; Group Chair), Prof R Wilks (Jamaica; Group Co-Chair), Dr B Legetic (PAHO/WHO, USA), Prof FP Cappuccio (UK; Sub-panel Chair), Dr O Dary (USA), Dr B Legowski (Canada), Dr Luz Maria Sanchez (Mexico), Dr Simón Barquera (Mexico)

As part of the implementation of the WHO Global Strategy on Diet, Physical Activity and Health and the 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases, WHO will convene three multistakeholder information exchange forums and technical meetings focusing on three aspects of population sodium reduction strategies:

  • Creating environments which enable the reduction of sodium intake. Building on existing experiences, which will focus on interventions for consumer education and reformulation of industrially produced foods to enable consumers to make appropriate choices to reduce the total sodium content of their diet.

  • Evaluating and monitoring population sodium consumption and sources of sodium in the diet. This will focus on identifying the appropriate tools and protocols that are effective to monitor and evaluate population sodium consumption and sources of sodium in the diet.

  • The role of fortified salt in iodine deficiency prevention. This will focus on analysing how the two strategies (salt reduction and iodine fortification) can efficiently and effectively work together for the benefit of populations affected.

It is expected that the outcomes of these meetings will constitute a useful resource for Member States and other stakeholders, when planning and implementing interventions aiming at reducing population-wide sodium intake.

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1. Creating enabling environment

Creating an enabling environment for population-based salt reduction strategies

London, UK, 30 June - 2 July 2010

In July 2010, the World Health Organization and the United Kingdom Food Standards Agency jointly convened a technical meeting in London on: "Creating an Enabling Environment for Population-based Salt Reduction Strategies." The meeting provided an opportunity for detailed discussion on interventions for consumer education and reformulation of industrially produced foods to enable consumers to make appropriate choices to reduce the total sodium content of their diet.

This report is a summary of the evidence and experiences presented during the technical meeting, as well as the discussions of the working group sessions and conclusions reached by the participants.

Read the Final Report here.

2. Evaluation and monitoring

Strategies to monitor and evaluate population sodium consumption and sources of sodium in the diet

Calgary, Canada, 19-20 October 2010

In October 2010, the World Health Organization and the Government of Canada jointly convened a technical meeting in Calgary on: "Strategies to monitor and evaluate population sodium consumption and sources of sodium in the diet." The meeting provided and opportunity for detailed discussions on monitoring sodium intake levels at population level, assessment of dietary sources of sodium, and knowledge, attitudes and behaviours towards sodium and health.

This report is a summary of the evidence and experiences presented during the technical meeting, as well as the discussions of the working group sessions and conclusions reached by the participants.

Read the Final Report here

Publications

  • Campbell N, Legowski B, Legetic B, Wilks R, Pinto de Almeida Vasconcellos AB on behalf of the PAHO/WHO Regional Expert Group on Cardiovascular Disease Prevention through Dietary Salt Reduction. PAHO/WHO Regional Expert Group Policy Statement: preventing cardiovascular disease in the Americas by reducing dietary salt intake population-wide. CVD Prevention and Control 2010;4:189-91
  • Campbell N, Legowski B, Legetic B (Group member: FP Cappuccio). Mobilising the Americas for dietary salt reduction. Lancet 2010; doi: 10.1016/50140-6736(10)60489-8
  • Campbell N, Cappuccio FP, Tobe SW. Unnecessary controversy regarding dietary sodium. A lot about a little. Can J Cardiol 2011; 27: 404-6
  • Campbell N, Correa-Rotter R, Neal B & Cappuccio FP. New evidence relsting to the health impact of reducing salt intake. Nutr Metab Cardiovasc Dis 2011; 21: 617-9
  • Campbell N, Dary O, Cappuccio FP, Neufeld LM, Harding KB & Zimmermann MB. Collaboration to optimize dietary intakes of salt and iodine. A critical but overlooked public health issue. Bull World Health Organization 2012; 90: 73-4
  • Cappuccio FP. Salt and cardiovascular disease. Br Med J 2007; 334: 859-60
  • Cappuccio FP. Overview and evaluation of national policies, dietary recommendtions and programmes around the world aiming at reducing salt intake in the population. World Health Organization. Reducing salt intake in populations: report of a WHO forum and technical meeting. WHO Geneva 2007; pp.1 – 60 (ISBN 978 92 4 159537 7)
  • Cappuccio FP & Capewell S. How to cut down salt intake in populations. Heart 2010;96:1863-4
  • Cappuccio FP. 'With a pinch of salt' revisited. Clin Med 2010;10(5): 518 (letter)
  • Cappuccio FP & Capewell S. A sprinkling of doubt. New Scientist 2010; 2758 (1 May); 22-23
  • Cappuccio FP, Pravst I. Health claims on foods: promoting healthy food choices or high salt intake? British Journal of Nutrition 2011; 106: 1770-1 (letter)
  • Cappuccio FP, Capewell S, Lincoln P & McPherson K. Policy options to reduce population salt intake. Br Med J 2011; 343: 402-5
  • Cappuccio FP & Ji C. Less salt and less risk of stroke: further support to action. Stroke 2012; in press (Editorial)
  • D'Elia L, Barba G, Cappuccio FP & Strazzullo P. Potassium intake, stroke and cardiovascular disease: a meta-analysis of prospective studies. Journal of the American College of Cardiology 2011; 57(10): 1210-1219
  • D'Elia L, Rossi G, Ippolito R, Cappuccio FP & Strazzullo P. Habitual salt intake and risk of gastric cancer: a meta-analysis of prospective studies. Clinical Nutrition 2012; doi: 10.1016/j.clnu.2012.01.003
  • He FJ, Appel LJ, Cappuccio FP, de Wardener HE, MacGregor GA. Does reducing salt intake increase cardiovascular mortality? Kidney International 2011; 378: 380-2
  • NHS National Institute for Health and Clinical Excellence. Prevention of cardiovascular disease at population level. NICE Public Health Guidance 25, June 2010
  • Venezia A, Barba G, Russo O, Capasso C, De Luca V, Farinaro E, Cappuccio FP, Galletti F, Rossi G & Strazzullo P. Dietary sodium intake in a sample of adult male population in southern Italy: results of the Olivetti Heart Study. Eur J Clin Nutr 2010; 64: 518-24
  • Ribič CH, Zakotnik JM, Vertnik L, Vegnuti M & Cappuccio FP. Salt intake of the Slovene population assessed by 24-hour urinary sodium excretion. Public Health Nutrition 2010; 13(11): 1803-9
  • Strazzullo P, D'Elia L, Kandala N-B & Cappuccio FP. Salt, stroke and cardiovascular disease: a meta-analysis of prospective studies. Br Med J 2009; 339: b4567
  • World Health Organization. Salt as a vehicle for fortification. Report of a WHO Expert Consultation. World Health Organization, Geneva, 2008; pp. 1-27 (ISBN 978-92-4-159678-7)
  • World Health Organization. Creating an enabling environment for population-based salt reduction strategies: report of a joint technical meeting held by WHO and the Food Standards Agency, United Kingdom, July 2010. World Health Organization, Geneva, 2010; pp. 1-42 (ISBN 978 92 4 150077 7)
  • World Health Organization. Strategies to monitor and evaluate population sodium consumption and sources of sodium in the diet: report of a joint technical meeting convened by WHO and the Government of Canada. Canada, October 2010. World Health Organization, Geneva, 2011; pp. 1-40 (ISBN 978 92 4 150169 9)

Head of Centre

Professor F. P. Cappuccio

Members

Professor E. Dowler

Mr C. Ji

Dr M.A. Miller