LETTER TO THE EDITOR A comprehensive review on salt and health and current experience of worldwide salt reduction programmes Journal of Human Hypertension (2009) 23, 771–772; doi:10.1038/jhh.2009.64; published online 3 September 2009 We read with great interest the excellent review article by He and MacGregor 1 on salt and health relationship and on worldwide salt-reducing pro- grammes. For several reasons this is a very critical health issue in Portugal, for which both the Portuguese Society of Hypertension and Portuguese health authorities have been recently strongly pawned. Among Western European countries, Portugal has one of the highest mortality rates for stroke (twice that of coronary disease) and of incidence of gastric cancer. 2 The first population study devoted to evaluate salt consumption in Portugal was recently undertaken and published. 3 In that study 3 (426 persons aged 22–72 years), the mean daily salt consumption measuring 24 h urinary sodium (validated by creatinuria) was found to be 11.9 ± 4.2 g day À1 (median ¼ 11.4 g salt day À1 ), which correlated with casual blood pressure and aortic stiffness. If we introduce such new data of Portu- guese salt consumption in the regression line plotting death from stroke and urinary sodium excretion, as shown in figure 8 of the article by He and MacGregor, 1 the position of Portugal will drop exactly within the regression line and not much above that line as it appears in figure 8. It also agrees more closely to the line plotting sodium excretion and death from stomach cancer as shown in figure 10. 1 All these data reinforce the message stressed by He and MacGregor 1 and suggest that such a high salt consumption might contribute both to the abnor- mally high mortality by stroke and gastric cancer in Portugal. In the past 2 years, we have tried to adopt a salt reduction policy similar to that undertaken in the United Kingdom and Finland, as explained in the article by He and MacGregor. 1 First, in the Portu- guese population studied, 3 subjects in the upper tercile of distribution of salt intake showed a significantly higher consumption of bread, red and raw meat and of flavourings, as compared with the lower and middle terciles. 4 By measuring sodium content in the mostly consumed types of Portuguese bread, an average of 19.2 g of salt per kilo bread was obtained, that is, 53% higher than that of bread collected in the other six European countries; in that regard, bread accounted for 21% of total daily sodium intake in the middle and upper terciles of salt consumption. 4 We then started to implement a population education intervention programme on the harmful consequences of salt and hypertension in mass media (TV, newspapers, radio), along with an educational campaign directed at food manufac- turers, health authorities and policy makers. A representative opinion survey showed that 72% of the Portuguese population considered themselves to be aware about high salt intake risks, 59% associated salt with hypertension and 25% declared having made efforts towards reducing salt intake during the last year. 4 With the purpose of providing national authorities and health professionals with a document summar- izing the present knowledge on salt intake in Portugal and the strategies to reduce it, an Interna- tional Forum on Salt was held in December 2008. It was concluded that policy on salt restriction should be directed towards salt included in food. In March 2009, as a result of these actions, the Portuguese Parliament approved a law restraining sodium content in bread and processed foods to a maximum of 14 g kg À1 food and instituted a labelling policy of salt content in food. 4 Considering the study by He and MacGregor as reference, we estimate that a reduction of 1 g day À1 of salt intake might save 2460 lives per year in Portugal. J Polonia 1,2 and L Martins 1,2 1 Faculty of Health Sciences, Fernando Pessoa University, Porto, Portugal and 2 Portuguese Society of Hypertension, Porto, Portugal E-mail: nop25569@mail.telepac.pt Published online 3 September 2009 References 1 He FJ, MacGregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens 2009; 23(6): 363–384. 2 Barros P, de Almeida Simo ˜ es J. Portugal: Health system review. Health Systems in Transition 2007; 9(5): 1–140. Journal of Human Hypertension (2009) 23, 771–772 & 2009 Macmillan Publishers Limited All rights reserved 0950-9240/09 $32.00 www.nature.com/jhh