How excess salt consumption exposes Nigerians to diseases

‘Folic acid with iodized salt prevents birth defects’

Health experts have urged Nigerians to reduce their salt consumption to prevent exposure to preventable Non-Communicable Diseases (NCDs) such as hypertension.

A recent survey conducted by Corporate Accountability and Public Participation Africa (CAPPA), shows that over 90 per cent of Nigerians recognise the health risks of excessive salt intake but most lack understanding of daily recommended limits or sources of high sodium in their diets.

According to experts, this knowledge gap exacerbates the increasing prevalence of NCDs, with hypertension linked to high salt intake accounting for 12 per cent of NCD-related deaths in Nigeria.

Senior Programme Manager, Food Justice Programme, CAPPA, Abayomi Sarumi, said the situation is a tricky one along with a growing call for mandatory salt limits in processed and packaged foods.

Sarumi emphasised that there is a spike in non-communicable diseases amongst Nigerians due to several factors, which primarily include unhealthy diets, especially excessive consumption of foods high in salt, sugar, and trans-fats.

“About 12 per cent of deaths due to NCDs are associated with hypertension due to high salt/sodium consumption. The profit-driven practices of food industries in Nigeria, including marketing high-salt foods as affordable, accessible, and healthy, significantly harm public health and contribute to the rise of non-communicable diseases (NCDs),” he added.

He explained that these industries often undermine government efforts by providing unhealthy relief materials during emergencies and weakening the push for healthier food policies.

“Unfortunately, these relief items compound the NCD problem; these CSRs are ways of weakening the government’s stance on healthy food policies. In response, the government needs to set mandatory limits,” he added.

On how to tackle the situation, Sarumi explained that while media awareness is critical, policy interventions have a population-wide impact. He insisted that effective and robust policies are needed together with media advocacy to protect Nigerians from the dangers of excessive salt consumption.

He added that while the 2023 National Agency for Food and Drug Administration and Control (NAFDAC) regulation on trans-fats is a positive step, there is an urgent need for mandatory sodium regulations, including front-of-pack warning labels (FOPWL), to guide consumer choices. “Government must open it channels for multi-stakeholder participation to amplify the conversation,” he said.

Technical Advisor, Network for Health Equity & Development (NHED), Dr Jerome Mafeni, who spoke at the 2024 media training on salt reduction, advised Nigerians to prioritise salt reduction and take meaningful steps towards reducing their daily salt intake.

He explained that implementing mandatory salt reduction targets will not only address the immediate health risks associated with high sodium consumption but also pave the way for long-term benefits in reducing the burden of cardiovascular diseases.

“We can work together to combat excessive salt consumption in Nigeria, improve public health outcomes, and create a healthier future for all Nigerians,” he said.

CAPPA Executive Director, Akinbode Oluwafemi, said Nigeria currently records an estimated daily salt consumption reaching up to 5.8 grams per day, which exceeds the World Health Organisation’s (WHO) recommended limit of 2 grams of sodium per day or less than 5 grams.

Oluwafemi said the recommendation is equivalent to just one teaspoon of salt daily and the public needs help to understand the dangers of their choices, especially when consumption is driven by a gap in knowledge. “We also constantly engage with government to put in place the relevant legislation to protect Nigerians,” he said.

MEANWHILE, a team of international researchers has demonstrated for the first time that using folic acid-fortified iodized table salt can prevent multiple severe birth defects like spina bifida and anencephaly.

For decades, mandatory staple food fortification with folic acid has been known to prevent permanent and life-threatening birth defects, such as spina bifida and anencephaly and women are often advised to have enough folic acid in their bodies before and during pregnancy.

However, approximately 260,000 births worldwide, which is about 20 per every 10,000 births are still affected by spina bifida and anencephaly, contributing to a high number of stillbirths, elective pregnancy terminations, and deaths of infants and young children globally.

Although the WHO recommends that all women should take supplement pills with 400 micrograms of folic acid daily, from the moment they begin attempting to conceive through the first three months of pregnancy; however, the World Health Assembly in 2023, adopted a resolution promoting food fortification with folic acid to accelerate the slow pace of prevention of spina bifida and other birth defects associated with low maternal folate levels at the time of early pregnancy.

In the new study by a team of international researchers at the University of Central Florida (UCF) and Emory University, published by JAMA Network Open, the experts noted that a solution is not only possible, but many people already have it on their kitchen tables.

Results from the clinical trial showed that mixing folic acid with commercially available iodized table salt, based on the existing average daily consumption of salt, increased serum folate levels among participants to levels needed for the prevention of spina bifida and anencephaly.

There was a significant increase of about 3.7-fold improvement before and after four months of using the study salt with iodine and folic acid. The study lead author and a neurosurgeon, UCF College of Medicine, Jogi Pattisapu said the results proved that folic acid could get into the blood through salt.

Pattisapu encouraged countries that have not implemented fortification programs to realize that salt fortification is cheap and easy to add the right amount of folic acid needed to save lives. “It might just turn the salt a little yellow, but the participants did not mind, and we know it works. What we need now is action,” he said.

According to the researchers, the impact of this new study could be felt globally in countries with successful salt iodization programs. An associate professor, Department of Epidemiology, Emory University’s Rollins School of Public Health, Vijaya Kancherla said they are preventable birth defects that cannot be cured once they occur.

Kancherla explained that surgeries and clinical care are expensive and largely unavailable in low- and middle-income countries which lead to most of the deaths of babies with spina bifida. “We have shown that salt has the potential to close the prevention gap now,” he added.

The researchers also made it clear the study does not promote salt intake, but rather adds the necessary amount of folic acid to the table salt already being consumed in regions.

They also advised an increase in the concentration of folic acid if the average daily salt consumption is reduced in the regions.

According to the experts, at least 50 per cent of the current global spina bifida cases would be prevented if the major, already existing iodized salt programs took the simple step of adding folic acid.

The Centre Director for Spina Bifida Prevention at Rollins, Godfrey Oakley, said, “We now know folic acid fortification of iodized salt can prevent folate deficiency that causes spina bifida, the stage is now set for a rapid acceleration of prevention of these birth defects in many countries.”