Background: The UK introduced an ambitious national strategy to reduce population levels of salt intake in 2003. The aim
of this study was to evaluate the impact of this strategy on salt intake in England, including potential effects on health
inequalities.
Methods: Secondary analysis of data from the Health Survey for England. Our main outcome measure was trends in
estimated daily salt intake from 2003–2007, as measured by spot urine. Secondary outcome measures were knowledge of
government guidance and voluntary use of salt in food preparation over this time period.
Results: There were significant reductions in salt intake between 2003 and 2007 (20.175grams per day per year, p,0.001).
Intake decreased uniformly across all other groups but remained significantly higher in younger persons, men, ethnic
minorities and lower social class groups and those without hypertension in 2007. Awareness of government guidance on
salt use was lowest in those groups with the highest intake (semi-skilled manual v professional; 64.9% v 71.0% AOR 0.76
95% CI 0.58–0.99). Self reported use of salt added at the table reduced significantly during the study period (56.5% to 40.2%
p,0.001). Respondents from ethnic minority groups remained significantly more likely to add salt during cooking (white
42.8%, black 74.1%, south Asian 88.3%) and those from lower social class groups (unskilled manual 46.6%, professional
35.2%) were more likely to add salt at the table.
Conclusions: The introduction a national salt reduction strategy was associated with uniform but modest reductions in salt
intake in England, although it is not clear precisely which aspects of the strategy contributed to this. Knowledge of
government guidance was lower and voluntary salt use and total salt intake was higher among occupational and ethnic
groups at greatest risk of cardiovascular disease.