Preface

This book, "Salt in the Earth", contains four sections. Section I is titled "The importance of salt in water usage" and it includes the study "Delineation of saltwater and fresh water interface between Kolleru Lake and Bay of Bengal coast, Andhra Pradesh, India, using remote sensing and GIS techniques" by Harikrishna Karanam. The author showed that seawater intrusion areas could be successful found using integrated data of hydrogeology, hydrochemistry, remote sensing, and geophysical investigations.

Section II is titled "Salt intake in human life" and this section contains two chapters. The first chapter is "The role of salt on food and human health" by Miguel Elias, Marta Laranjo, Ana Cristina Agulheiro-Santos, and Maria Eduarda Potes. This chapter reports on the social and economic importance of salt throughout human history. The second chapter is on the "Systematic reduction of excessive salt intake" by Boris Kovač and Urška Blaznik and this describes the importance of salt intake and the importance of salt reduction in food.

Section III covers the main topic "Salt in technology" with two chapters. The first chapter, "Short review of salt recovery from reverse osmosis rejects" by Boopathy Ramasamy, covers some aspects of the route of water recovery. The author describes common methods to treat saline streams. The second chapter, "Upward capillary mass transfer as a process for growing concentration zones" by Alexandr Mikhailov, Ivan I. Vashlaev, Margarita Yu Kharitonova, and Margarita L. Sviridova, shows the advantages of the phenomenon of surface salinization of the soil layer. The chapter presents the results of experimental studies of ascending mass transfer of useful components from the waste material of the concentrating production of nonferrous metals.

Section IV, "The importance of salt in road safety", includes the chapter "NaCl material for winter maintenance and its environmental effect" by Durickovic Ivana. In this chapter, the effects of road salts used as a deicer during winter maintenance were investigated along with its chemical properties. The study is supported in general by many different methods with different examples and a wide literature background.

> **Dr. Mualla Cengiz** Professor, Istanbul University - Cerrahpaşa, Department of Geophysical Engineering, Istanbul, Turkey

#### **Savas Karabulut, Ph.D.**

Union of Chambers of Turkish Engineers and Architects, The Branch of Geophysical Engineering, Ankara, Turkey

Section 1

The Importance of Salt

in Water Usage

1

Section 1

## The Importance of Salt in Water Usage

Chapter 1

Abstract

the coast to the lake.

remote sensing and GIS

Kolleru Lake is extends upto 9036.30 km<sup>2</sup>

1. Introduction

3

Delineation of Salt Water and

Fresh Water Interface between

Kolleru Lake and Bay of Bengal

India – Using Remote Sensing

Kolleru Lake is the largest natural fresh water lake located between Godavari and Krishna deltas in Andhra Pradesh in India and is acting as a natural flood balancing reservoir. Dynamic land use changes from lake bed and agricultural land to aqua-culture and overexploitation of groundwater are becoming the major causes for salt-water intrusion. Changing of land use patterns is highly influencing on the quality of water. Paleo beach ridges are having potential aquifers around the Kolleru Lake. The main aim of this study is to identify seawater intrusion areas and reasons for intrusion. Integrated study of hydrogeology, hydrochemistry, remote sensing and geophysical investigations exposed the extent of salt-water intrusion up to the northern part of the lake, which is about 42 km away from the Bay of Bengal coast line. Top layer resistivity is more than 10 ohm-m in case of sand formations,

2–10 ohm-m in case of brackish water saturated formations and less than

Keywords: Kolleru Lake, saltwater intrusion, overly techniques,

1.0 ohm-m in case of saline water saturation aquifers, and clay-rich layers shows the resistivity in the range of 2 to 5 ohm-m. Remote sensing data and GIS (Geographical Information System) helped us to trace two major sea water intrusion patches from

Kolleru is one of the biggest shallow fresh water lakes in India which is located between the deltas of Godavari and Krishna Rivers of the Andhra Pradesh, India. The lake collects water by over 69 inflowing drains and channels. The catchment of

people is agriculture and fishing. Since last three decades aquaculture is developed inside the coastal area encroached into the agricultural lands and into the Kolleru

. The major occupation of the surrounding

Coast, Andhra Pradesh,

and GIS Techniques

Harikrishna Karanam

#### Chapter 1

## Delineation of Salt Water and Fresh Water Interface between Kolleru Lake and Bay of Bengal Coast, Andhra Pradesh, India – Using Remote Sensing and GIS Techniques

Harikrishna Karanam

### Abstract

Kolleru Lake is the largest natural fresh water lake located between Godavari and Krishna deltas in Andhra Pradesh in India and is acting as a natural flood balancing reservoir. Dynamic land use changes from lake bed and agricultural land to aqua-culture and overexploitation of groundwater are becoming the major causes for salt-water intrusion. Changing of land use patterns is highly influencing on the quality of water. Paleo beach ridges are having potential aquifers around the Kolleru Lake. The main aim of this study is to identify seawater intrusion areas and reasons for intrusion. Integrated study of hydrogeology, hydrochemistry, remote sensing and geophysical investigations exposed the extent of salt-water intrusion up to the northern part of the lake, which is about 42 km away from the Bay of Bengal coast line. Top layer resistivity is more than 10 ohm-m in case of sand formations, 2–10 ohm-m in case of brackish water saturated formations and less than 1.0 ohm-m in case of saline water saturation aquifers, and clay-rich layers shows the resistivity in the range of 2 to 5 ohm-m. Remote sensing data and GIS (Geographical Information System) helped us to trace two major sea water intrusion patches from the coast to the lake.

Keywords: Kolleru Lake, saltwater intrusion, overly techniques, remote sensing and GIS

#### 1. Introduction

Kolleru is one of the biggest shallow fresh water lakes in India which is located between the deltas of Godavari and Krishna Rivers of the Andhra Pradesh, India. The lake collects water by over 69 inflowing drains and channels. The catchment of Kolleru Lake is extends upto 9036.30 km<sup>2</sup> . The major occupation of the surrounding people is agriculture and fishing. Since last three decades aquaculture is developed inside the coastal area encroached into the agricultural lands and into the Kolleru

Lake also [1]. The main drinking water source to this area people is ground water. Potable groundwater is available in beach ridges in the range of 3–5 m depth and many houses having an open well. An endeavor is made to know the problem with multidisciplinary loom to propose some elucidation to develop the drinking water situation particularly the area between lake and the coast area.

Prolonged water logging conditions during the active monsoon periods due to poor drainage is not uncommon. Especially in drought time these wetlands are the best source to ground water potential and will play a major role in flood control at the time of active monsoon. Over past six decades the shifting of fresh water lake to agriculture land; and agriculture to aquaculture; and finally finishing to the aquaculture demolition was driven by the demanded economic benefit surpassing ecological and social community growth. Saltwater intrusion is adulterated coastal aquifers predominantly in and around the Kolleru lake region, most of the farmers to get aquaculture as an extracommercial source of income, where salt water is used from the nearby creaks [2]. Saline or brackish groundwater is present below fresh groundwater in deltaic and coastal areas [3]. Due to overexploitation of groundwater in many parts of India and worldwide the coastal aquifers are generally fragile in nature and the shallow aquifers are easily depleted [4]. Remote sensing and geophysical, geochemical and GIS techniques are used to directly or indirectly supervise saltwater in coastal aquifers. However, high TDS (Total dissolved solids) concentration or specific conductance of groundwater samples are other indicators of groundwater salinity [5]. Electrical Resistivity survey is the best method to discriminate the sub-surface layers includes aquifers and to certain extent the quality of groundwater [6]. Through the spatial distribution of electrical conductivity, we can assess the presence of dissolved ions in a coastal aquifer [7].

#### 2. Study area

The study area lies in between the delta regions of Krishna and Godavari rivers which covers 31 revenue blocks (Mandals) out of that 16 revenue blocks in West Godavari district and 15 revenue blocks in Krishna district of Andhra Pradesh, India. The total area covered in this study is about 3861.97 km<sup>2</sup> lying in between 80<sup>o</sup> 50<sup>0</sup> to 81<sup>o</sup> 39<sup>0</sup> E longitude and 16o 17<sup>0</sup> to 16<sup>o</sup> 59' N latitude. Location map of the study area is shown in Figure 1.

sandstone and the geology map of the investigation area is shown in Figure 2. The geometry of the Kolleru-Upputeru catchment is guided by the regional lineaments. The most dominant directions of these lineaments are NW-SE and NE–SW. The density of fractures/lineaments is more in Archaean metamorphic rocks and Gondwanas of Chintalapudi sub-basin than East-coast Gondwanas and Rajahmundry sandstones. The structures in the area control the occurrence and movement of

Delineation of Salt Water and Fresh Water Interface between Kolleru Lake and Bay of Bengal…

DOI: http://dx.doi.org/10.5772/intechopen.90448

The methods adopted during the course of this investigation have been presented below. Standard scientific methods were used for laboratory investiga-

tion. The methodology has been presented as follows.

• Interpretation of field data and integration

ground water.

5

Figure 1.

Location map of the study area.

3. Methodology

• Remote Sensing methods

• Integration of chemical data

• Electrical Resistivity survey

#### 2.1 Geology

The study area is engaged by recent alluvium and forms a part of Krishna and Godavari deltas. Deltas are the results of the continuous supply of sediment by rivers to coasts and upper continental shelves. They make the largest latent places for the clastic sediments and the shape is mostly a lobe like extension of the coast with a number of divisions. The main axes of the delta run typical to the regional depositional strike. In general the area is occupied by clays, silts, silty clays and silty sands with variable thickness ranging from 1.5 to 3.5 m. These are under laid by sandy layers of variable thickness ranging from 1.5 to 4.5 m in the beach ridge regions and paleochannels. The deltaic plains are occupied by clays and silty clays and extend to a maximum depth of about 2 m. These clays are under laid by saturated clay deposits extending up to greater depths. Main geological features in this study area are active beach, flood plain, Gollapalli formation, Gollapalli/ Chintalapudi sandstone, khondalite, Kolleru formation, Kolleru Lake, laterite, paleo beach ridges, paleo channel, paleo tidal flat, Rajahmundry sandstone and Tirupati

Delineation of Salt Water and Fresh Water Interface between Kolleru Lake and Bay of Bengal… DOI: http://dx.doi.org/10.5772/intechopen.90448

Figure 1. Location map of the study area.

Lake also [1]. The main drinking water source to this area people is ground water. Potable groundwater is available in beach ridges in the range of 3–5 m depth and many houses having an open well. An endeavor is made to know the problem with multidisciplinary loom to propose some elucidation to develop the drinking water

Prolonged water logging conditions during the active monsoon periods due to poor drainage is not uncommon. Especially in drought time these wetlands are the best source to ground water potential and will play a major role in flood control at the time of active monsoon. Over past six decades the shifting of fresh water lake to agriculture land; and agriculture to aquaculture; and finally finishing to the aquaculture demolition was driven by the demanded economic benefit surpassing ecological and social community growth. Saltwater intrusion is adulterated coastal aquifers predominantly in and around the Kolleru lake region, most of the farmers to get aquaculture as an extracommercial source of income, where salt water is used from the nearby creaks [2]. Saline or brackish groundwater is present below fresh groundwater in deltaic and coastal areas [3]. Due to overexploitation of groundwater in many parts of India and worldwide the coastal aquifers are generally fragile in nature and the shallow aquifers are easily depleted [4]. Remote sensing and geophysical, geochemical and GIS techniques are used to directly or indirectly supervise saltwater in coastal aquifers. However, high TDS (Total dissolved solids) concentration or specific conductance of groundwater samples are other indicators of groundwater salinity [5]. Electrical Resistivity survey is the best method to discriminate the sub-surface layers includes aquifers and to certain extent the quality of groundwater [6]. Through the spatial distribution of electrical conductivity, we can assess the presence of dissolved ions in a coastal aquifer [7].

The study area lies in between the delta regions of Krishna and Godavari rivers which covers 31 revenue blocks (Mandals) out of that 16 revenue blocks in West Godavari district and 15 revenue blocks in Krishna district of Andhra Pradesh, India. The total area covered in this study is about 3861.97 km<sup>2</sup> lying in between 80<sup>o</sup> 50<sup>0</sup> to 81<sup>o</sup> 39<sup>0</sup> E longitude and 16o 17<sup>0</sup> to 16<sup>o</sup> 59' N latitude. Location map of the study

The study area is engaged by recent alluvium and forms a part of Krishna and Godavari deltas. Deltas are the results of the continuous supply of sediment by rivers to coasts and upper continental shelves. They make the largest latent places for the clastic sediments and the shape is mostly a lobe like extension of the coast with a number of divisions. The main axes of the delta run typical to the regional depositional strike. In general the area is occupied by clays, silts, silty clays and silty sands with variable thickness ranging from 1.5 to 3.5 m. These are under laid by sandy layers of variable thickness ranging from 1.5 to 4.5 m in the beach ridge regions and paleochannels. The deltaic plains are occupied by clays and silty clays and extend to a maximum depth of about 2 m. These clays are under laid by saturated clay deposits extending up to greater depths. Main geological features in this study area are active beach, flood plain, Gollapalli formation, Gollapalli/ Chintalapudi sandstone, khondalite, Kolleru formation, Kolleru Lake, laterite, paleo beach ridges, paleo channel, paleo tidal flat, Rajahmundry sandstone and Tirupati

situation particularly the area between lake and the coast area.

2. Study area

Salt in the Earth

2.1 Geology

4

area is shown in Figure 1.

sandstone and the geology map of the investigation area is shown in Figure 2. The geometry of the Kolleru-Upputeru catchment is guided by the regional lineaments. The most dominant directions of these lineaments are NW-SE and NE–SW. The density of fractures/lineaments is more in Archaean metamorphic rocks and Gondwanas of Chintalapudi sub-basin than East-coast Gondwanas and Rajahmundry sandstones. The structures in the area control the occurrence and movement of ground water.

### 3. Methodology

The methods adopted during the course of this investigation have been presented below. Standard scientific methods were used for laboratory investigation. The methodology has been presented as follows.


Salt in the Earth

fresh groundwater and shallow areas are deposited with saltwater. Almost all five strand lines are indicated that beach is slowly move away from the lake since

Delineation of Salt Water and Fresh Water Interface between Kolleru Lake and Bay of Bengal…

Totally 175 wells were selected to observe the groundwater table fluctuations for three continuous year during the research period and collected 175 water samples which covers the total study area and the locations of these wells are presented on the geomorphology map as shown in Figure 3. Water levels are measured with automatic water level indicator and coordinates were measured with Global positioning system (GPS) and 50% of the wells indicated more than 3.0 m depth of

The land use/ land cover map evidently shows that agricultural land is higher than others shown in Figure 4a. But since two decades aquaculture is abundantly increasing (Figure 4b). The results shows that the Kolleru lake in and around has good aquaculture potential (27.91% of TGA aquaculture) and agricultural land is 60.72%(include plantations, fallow land and horticulture) total geographical area of the study area. The land use/land cover categories like extent of the lake, aquaculture, cropland, and built-up land are mapped for 1985 and 2013 "Figure 4a and b". A buffer of 1 km interval is drawn from lake to 5 km. It is observed that the area

) till 2005.

under aquaculture within the lake has gradually increased (128 km<sup>2</sup>

Holocene period.

Figure 3.

7

3.1.2 Hydrogeology

water table during pre-monsoon period.

Wells and VES locations on geomorphology map.

DOI: http://dx.doi.org/10.5772/intechopen.90448

3.1.3 Land use/land cover dynamics

Figure 2. Geology map of the study area.

#### 3.1 Remote sensing methods

Remote sensing has become the most powerful scientific tool for the study of various Earth resources and related features. The advent of colored satellite imageries has revolutionized the Remote Sensing activity. Survey of India toposheets of 1:50,000 scale maps were Geo-referenced than mosaic all the images in order and choose AOI (Area of Interest) with sub setting images (65D/13, 65D/14, 65D/15, 65H/1, 65H/2, 65H/3, 65H/4, 65H/5, 65H/6, 65H/7, 65H/8, 65H/9, 65H/10, and 65H/11) was done to extract the study area. IRS P6 LISS IV of March, 2014 digital satellite data is used for land use/land cover, geology and geomorphology studies.

#### 3.1.1 Geomorphology

The major geomorphological features are flood plain deposition, lake bed, beach ridges and marine built plains are shown in Figure 3. Ridges are having potable

Delineation of Salt Water and Fresh Water Interface between Kolleru Lake and Bay of Bengal… DOI: http://dx.doi.org/10.5772/intechopen.90448

#### Figure 3. Wells and VES locations on geomorphology map.

fresh groundwater and shallow areas are deposited with saltwater. Almost all five strand lines are indicated that beach is slowly move away from the lake since Holocene period.

#### 3.1.2 Hydrogeology

Totally 175 wells were selected to observe the groundwater table fluctuations for three continuous year during the research period and collected 175 water samples which covers the total study area and the locations of these wells are presented on the geomorphology map as shown in Figure 3. Water levels are measured with automatic water level indicator and coordinates were measured with Global positioning system (GPS) and 50% of the wells indicated more than 3.0 m depth of water table during pre-monsoon period.

#### 3.1.3 Land use/land cover dynamics

The land use/ land cover map evidently shows that agricultural land is higher than others shown in Figure 4a. But since two decades aquaculture is abundantly increasing (Figure 4b). The results shows that the Kolleru lake in and around has good aquaculture potential (27.91% of TGA aquaculture) and agricultural land is 60.72%(include plantations, fallow land and horticulture) total geographical area of the study area. The land use/land cover categories like extent of the lake, aquaculture, cropland, and built-up land are mapped for 1985 and 2013 "Figure 4a and b". A buffer of 1 km interval is drawn from lake to 5 km. It is observed that the area under aquaculture within the lake has gradually increased (128 km<sup>2</sup> ) till 2005.

3.1 Remote sensing methods

Geology map of the study area.

Figure 2.

Salt in the Earth

3.1.1 Geomorphology

6

Remote sensing has become the most powerful scientific tool for the study of various Earth resources and related features. The advent of colored satellite imageries has revolutionized the Remote Sensing activity. Survey of India toposheets of 1:50,000 scale maps were Geo-referenced than mosaic all the images in order and choose AOI (Area of Interest) with sub setting images (65D/13, 65D/14, 65D/15, 65H/1, 65H/2, 65H/3, 65H/4, 65H/5, 65H/6, 65H/7, 65H/8, 65H/9, 65H/10, and 65H/11) was done to extract the study area. IRS P6 LISS IV of March, 2014 digital satellite

The major geomorphological features are flood plain deposition, lake bed, beach ridges and marine built plains are shown in Figure 3. Ridges are having potable

data is used for land use/land cover, geology and geomorphology studies.

#### Figure 4.

(a) Dynamic land use changes within and around the lake during – 1985; (b) dynamic land use changes within and around the lake during – 2013.

#### 3.1.4 Hydrology

The area is drained by five major hydrological systems that include Budameru, Ramileru, Tammileru, Gunderu and Errakalava of which the first four directly flow and let water into Kolleru whereas, Errakalava linked near to the mouth of Upputeru by construction of Enamadurru drain and thus falls into Upputeru Subcatchment. These rivers are ephemeral in nature and flow in response to rainfall and are influent to effluent in nature. The hydrological system depicting the Kolleru-Upputeru catchment and their watersheds is shown in Figure 5.

#### 3.2 Integration of chemical data

Chemical parameters of groundwater samples are well explained above comparing the WHO and BIS standards [8, 9]. Broadly the areas of maximum desirable, maximum permissible and beyond permissible limits are demarcated. Red boundary line enclosure in Figure 6 is highest TDS area. Same area with same geographical coordinates superposed over the thematic maps of all over the other 8 parameters like Electrical conductivity, salinity, Chlorides, Sodium, Hardness, Potassium, Calcium and Magnesium. Figure 6(a) is the areal distribution of TDS and Figure 6(b) is the aerial distribution of Ca over which the border line of beyond allowable limit of TDS is super posed. Similarly TDS is superposed over the other six parameters. Surprisingly all the chemical parameters high concentration is showing in two patches.

#### 3.3 Resistivity survey

Electrical resistivity survey is one of the best technique to demarcate aquifer composition, groundwater, bedrock, and fresh/salt zones [10]. To delineating the shallow and deep aquifers using with Schlumberger configuration were made in the recent past [11, 12]. In this work the same method has been utilized to demarcate interface of different natures of water. The additional leaky or fissured a rock,

Delineation of Salt Water and Fresh Water Interface between Kolleru Lake and Bay of Bengal…

DOI: http://dx.doi.org/10.5772/intechopen.90448

Comparison of TDS high concentrations with other parameters.

Figure 5.

Figure 6.

9

Hydrological map of Kolleru catchment.

Delineation of Salt Water and Fresh Water Interface between Kolleru Lake and Bay of Bengal… DOI: http://dx.doi.org/10.5772/intechopen.90448

Figure 5. Hydrological map of Kolleru catchment.

3.1.4 Hydrology

Salt in the Earth

Figure 4.

patches.

8

3.3 Resistivity survey

3.2 Integration of chemical data

within and around the lake during – 2013.

The area is drained by five major hydrological systems that include Budameru, Ramileru, Tammileru, Gunderu and Errakalava of which the first four directly flow

(a) Dynamic land use changes within and around the lake during – 1985; (b) dynamic land use changes

Chemical parameters of groundwater samples are well explained above comparing the WHO and BIS standards [8, 9]. Broadly the areas of maximum desirable, maximum permissible and beyond permissible limits are demarcated. Red boundary line enclosure in Figure 6 is highest TDS area. Same area with same geographical coordinates superposed over the thematic maps of all over the other 8 parameters like Electrical conductivity, salinity, Chlorides, Sodium, Hardness, Potassium, Calcium and Magnesium. Figure 6(a) is the areal distribution of TDS and Figure 6(b) is the aerial distribution of Ca over which the border line of beyond allowable limit of TDS is super posed. Similarly TDS is superposed over the other six parameters. Surprisingly all the chemical parameters high concentration is showing in two

Electrical resistivity survey is one of the best technique to demarcate aquifer composition, groundwater, bedrock, and fresh/salt zones [10]. To delineating the

and let water into Kolleru whereas, Errakalava linked near to the mouth of Upputeru by construction of Enamadurru drain and thus falls into Upputeru Subcatchment. These rivers are ephemeral in nature and flow in response to rainfall and are influent to effluent in nature. The hydrological system depicting the Kolleru-

Upputeru catchment and their watersheds is shown in Figure 5.

Figure 6.

Comparison of TDS high concentrations with other parameters.

shallow and deep aquifers using with Schlumberger configuration were made in the recent past [11, 12]. In this work the same method has been utilized to demarcate interface of different natures of water. The additional leaky or fissured a rock,

the lower the resistivity. Higher degree of saturation or greater amount of water presents in pore spaces and fissures also decreases the resistivity [13].

Top soils are having resistivity varies between 3 and 68 ohm-m in paleo beach ridges, lake plain and uplands. Flood plain deposition, marine lagoon plain and marine built plain having top soil resistivity varies between 2 to 27, 1 to 15 and 0.3 to 15 ohm-m, respectively. Paleo beach ridges which are having fresh potable water is having top soil resistivity between 8 and 50 ohm m. Spatial distribution of top layer resistivity has shown in Figure 7.

In the present chapter, geophysical resistivity studies and chemical analyses of ground water of different open wells are compared. Finally, an attempt made to compared analysis of Vertical Electrical Soundings (VES) data and chemical data of observation wells nearby sounding resistivity location which are more related.

#### 3.4 Integration

Geographical Information system (GIS) is one of the best tool to identify salt water intrusion zones [14]. The heavy concentration of saltwater in ground water is represented the form of a map using weighted overlay techniques of ArcGIS.

Another important aspect of geographic information system (GIS) is that it enables the analysis of the spatial data and their attributes contained in the database. We have analyzed all the data layers through the process called "Overlay" in ArcGIS 9.3. Index Overlay is a best spatial action in which superimposed of many thematic layers onto another to form a new layer. This kind of overlay is also called "Arithmetic overlay," which means that values assigned to two or more input themes are

Broad classification of groundwater as per the integration of hydrochemical data and electrical resistivity.

Delineation of Salt Water and Fresh Water Interface between Kolleru Lake and Bay of Bengal…

DOI: http://dx.doi.org/10.5772/intechopen.90448

In this case the map classes exciting on each input layers are assigned different scores, as well as the maps have to assign different weights as before. It is suitable to describe the scores in an attribute Table for each input map. The averages score is

> <sup>i</sup> sij wi Σn <sup>i</sup> wi

<sup>s</sup> <sup>¼</sup> <sup>Σ</sup><sup>n</sup>

combined arithmetically (+, �, \*, /) to produce an output grid [15].

than defined by the equation

Figure 8.

11

Figure 7. Spatial distribution of top layer resistivity.

Delineation of Salt Water and Fresh Water Interface between Kolleru Lake and Bay of Bengal… DOI: http://dx.doi.org/10.5772/intechopen.90448

Figure 8. Broad classification of groundwater as per the integration of hydrochemical data and electrical resistivity.

Another important aspect of geographic information system (GIS) is that it enables the analysis of the spatial data and their attributes contained in the database. We have analyzed all the data layers through the process called "Overlay" in ArcGIS 9.3. Index Overlay is a best spatial action in which superimposed of many thematic layers onto another to form a new layer. This kind of overlay is also called "Arithmetic overlay," which means that values assigned to two or more input themes are combined arithmetically (+, �, \*, /) to produce an output grid [15].

In this case the map classes exciting on each input layers are assigned different scores, as well as the maps have to assign different weights as before. It is suitable to describe the scores in an attribute Table for each input map. The averages score is than defined by the equation

$$\mathfrak{T} = \frac{\Sigma\_i^n s\_{\vec{\eta}} \, w\_i}{\Sigma\_i^n w\_i}$$

the lower the resistivity. Higher degree of saturation or greater amount of water

Top soils are having resistivity varies between 3 and 68 ohm-m in paleo beach ridges, lake plain and uplands. Flood plain deposition, marine lagoon plain and marine built plain having top soil resistivity varies between 2 to 27, 1 to 15 and 0.3 to 15 ohm-m, respectively. Paleo beach ridges which are having fresh potable water is having top soil resistivity between 8 and 50 ohm m. Spatial distribution of top layer

In the present chapter, geophysical resistivity studies and chemical analyses of ground water of different open wells are compared. Finally, an attempt made to compared analysis of Vertical Electrical Soundings (VES) data and chemical data of observation wells nearby sounding resistivity location which are more related.

Geographical Information system (GIS) is one of the best tool to identify salt water intrusion zones [14]. The heavy concentration of saltwater in ground water is represented the form of a map using weighted overlay techniques of ArcGIS.

presents in pore spaces and fissures also decreases the resistivity [13].

resistivity has shown in Figure 7.

3.4 Integration

Salt in the Earth

Figure 7.

10

Spatial distribution of top layer resistivity.

#### where

s = Weighted score for an area object (polygon, pixels)

Sij = Score for the j-th class of the i-th map

Wi = Weighted score for the i-th map

Binary map analysis, Fuzzy logic and Index Overlay with Multi-class maps are some other methods available to determine inter class dependencies or inter map dependencies. Here an attempt has been made to use multi class maps in Index overlay method [16].

The input layers which are considered for the analysis of groundwater vulnerability zones are Salinity, TDS, Resistivity, EC, TH, Na, Cl, Ca, Mg, K, N03, S04, TA and PH.

To calculate sum of weighted conditions and divided by normalization factor

New Vulnerability Map ¼ ½ ∗ Ml þ ∗ M2 þ ∗ M3 þ ∗ M4 þ ∗ M5 þ ∗ M6 þ ∗ M7 þ ∗ M8 þ ∗ M9 þ ∗ M10 þ ∗ M11 þ ∗ M12 þ ∗ M13 þ ∗ M14� SUM

According to the levels of concentrations of these chemical parameters and resistivity of the top layer in the study area these were given with a fastidious weightage number and operated to obtain a map which is used for further analysis. Hence, calculated the each grid cell data and represented in the form of map showing the saline and non-saline groundwater zones in Figure 8. Fresh ground water is available in uplands, flood plains and paleo beach ridge zones. The areas of paleo lagoons (Figure 8), marine plains, marine marshy lands shown in the non potable groundwater zones. Saline groundwater zones broaden into the lake area and the continuous big brown patch between lake and the coast may be the main route of salt water intrusion towards the land. There are several potable groundwater patches in pink color close to the coast which may be due to presence of sand dunes that hold the fresh water.

#### 4. Conclusion

The results of this study clearly indicate that the sea water intrusion is taking place on both sides of the Kolleru lake through paleo channels. One big seawater intrusion zone was identified along the Upputeru river of 40 Km length from the coast to Lake. 70 out of 174 groundwater samples are non saline (40.2%), 37 samples are slightly saline (21.3%) and 67 samples are saline (38.5%). These statistics shows that potable groundwater is present in 40% of the total well locations. Most of the freshwater wells existed in the uplands of Kolleru Lake. Iso-resistivity contours of vertical cross sections clearly indicate the fresh and salt water zones. Areal mapping of fresh water aquifers (2023 sq.km) and sea water intrusion (784 sq.km) are also demarcated.

Author details

India

13

Harikrishna Karanam

provided the original work is properly cited.

Sanketika Vidya Parishad Engineering College, Visakhapatnam, Andhra Pradesh,

Delineation of Salt Water and Fresh Water Interface between Kolleru Lake and Bay of Bengal…

DOI: http://dx.doi.org/10.5772/intechopen.90448

\*Address all correspondence to: harigis2007@gmail.com; drhkkaranam@gmail.com

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

Delineation of Salt Water and Fresh Water Interface between Kolleru Lake and Bay of Bengal… DOI: http://dx.doi.org/10.5772/intechopen.90448

### Author details

where

Salt in the Earth

overlay method [16].

New Vulnerability Map ¼

dunes that hold the fresh water.

4. Conclusion

are also demarcated.

12

S04, TA and PH.

s = Weighted score for an area object (polygon, pixels)

Binary map analysis, Fuzzy logic and Index Overlay with Multi-class maps are some other methods available to determine inter class dependencies or inter map dependencies. Here an attempt has been made to use multi class maps in Index

To calculate sum of weighted conditions and divided by normalization factor

½ ∗ Ml þ ∗ M2 þ ∗ M3 þ ∗ M4 þ ∗ M5 þ ∗ M6 þ ∗ M7 þ ∗ M8 þ ∗ M9 þ ∗ M10 þ ∗ M11 þ ∗ M12 þ ∗ M13 þ ∗ M14� SUM

According to the levels of concentrations of these chemical parameters and resistivity of the top layer in the study area these were given with a fastidious weightage number and operated to obtain a map which is used for further analysis. Hence, calculated the each grid cell data and represented in the form of map showing the saline and non-saline groundwater zones in Figure 8. Fresh ground water is available in uplands, flood plains and paleo beach ridge zones. The areas of paleo lagoons (Figure 8), marine plains, marine marshy lands shown in the non potable groundwater zones. Saline groundwater zones broaden into the lake area and the continuous big brown patch between lake and the coast may be the main route of salt water intrusion towards the land. There are several potable groundwater patches in pink color close to the coast which may be due to presence of sand

The results of this study clearly indicate that the sea water intrusion is taking place on both sides of the Kolleru lake through paleo channels. One big seawater intrusion zone was identified along the Upputeru river of 40 Km length from the coast to Lake. 70 out of 174 groundwater samples are non saline (40.2%), 37 samples are slightly saline (21.3%) and 67 samples are saline (38.5%). These statistics shows that potable groundwater is present in 40% of the total well locations. Most of the freshwater wells existed in the uplands of Kolleru Lake. Iso-resistivity contours of vertical cross sections clearly indicate the fresh and salt water zones. Areal mapping of fresh water aquifers (2023 sq.km) and sea water intrusion (784 sq.km)

The input layers which are considered for the analysis of groundwater vulnerability zones are Salinity, TDS, Resistivity, EC, TH, Na, Cl, Ca, Mg, K, N03,

Sij = Score for the j-th class of the i-th map Wi = Weighted score for the i-th map

> Harikrishna Karanam Sanketika Vidya Parishad Engineering College, Visakhapatnam, Andhra Pradesh, India

\*Address all correspondence to: harigis2007@gmail.com; drhkkaranam@gmail.com

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

### References

[1] Harikrishna K, RamprasadNaik D, VenkateswaraRao T, Jaisankar G, VenkateswaraRao V. A study on saltwater intrusion around Kolleru Lake, Andhra Pradesh, India. International Journal of Engineering and Technology. 2012;4(3):133-139

[2] Harikrishna K, VenkateswaraRao V, RamprasadNaik D, Jaisankar G, Amminedu E. Hydrogeological & Geophysical studies for delineation of freshwater source in the paleo beach ridges around Kolleru Lake, Andhra Pradesh. International Journal on Emerging Trends in Technology (IJETT). 2013a;4(3): 251-257

[3] Narayan KA, Schleeberger C, Bristow C. Modelling seawater intrusion in the Burdekin Delta irrigation area, North Queensland, Australia. Agricultural Water Management. 2007; 89(3):217-228

[4] Mondal C, Singh P, Singh S, Saxena K. Determining the interaction between saline water and groundwater through groundwater major ions chemistry. Journal of Hydrology. 2010; 388(1–2):100-111

[5] Kalpan C, Saha DK. Integrated geophysical and chemical study of saline water intrusion. Ground Water. 2004; 42(5):671-677

[6] Harikrishna K, Appala Raju G, Venkateswara Rao V, Jaisankar G, Amminedu E. Land use/land cover patterns in and around Kolleru lake, Andhra Pradesh, India using RS and GIS techniques. nternational Journal of Remote Sensing and Geosciences. 2013; 2(2):1-7

[7] Albouy Y, Andrieux P, Rakotondrasoa G, Ritz M, Descloitres M, Join L, et al. Mapping coastal aquifers by joint inversion of DC and TEM soundings 3 cases histories. Ground Water. 2001;39(1):87-97

[15] ESRI. Getting to Know ArcGIS.

DOI: http://dx.doi.org/10.5772/intechopen.90448

Delineation of Salt Water and Fresh Water Interface between Kolleru Lake and Bay of Bengal…

[16] Bonham Carter GF. Geographic Information System for Geoscientists: Modeling with GIS. The Boulevare, Langford Lane, Kidlington, OX5 1GB, U.K.: Elsevier Science Ltd.; 2002

Redlands: ESRI Press; 2001

15

[8] World Health Organization (WHO). Guidelines for Drinking Water Quality. 3rd ed. Geneva, Switzerland. London: IWA Publishing; 2008

[9] Beuro of Indian Standards for Drinking water (BIS); Drinking Water — Specification (Second Revision), New Delhi: BIS; 2012

[10] Griffiths DH, Barker RD. Twodimensional resistivity imaging and modelling in areas of complex geology. Journal of Applied Geophysics. 1993;29 (3–4):211-226

[11] Selvam S, Sivasubramaniam P. Groundwater potential zone identification using geoelectrical survey: A case study from Medak district, Andhra Pradesh, India. International Journal of Geomatics and Geosciences. 2012;3(1):55-62

[12] Oyedele KF, Ogagarue DO, Esse O. Groundwater potential evaluation using surface geophysics at Oru-Imope, South-Western Nigeria. European Journal of Scientific Research. 2011; 63(4):515-522

[13] Griffiths E. Soil structure. In: A System for Description and Interpretation for Permeability Assessment. New Zealand: Soil Bureau District Office Report HV14, Department of Scientific and Industrial Research; 1986

[14] Hari krishna K, Ramprasad Naik D, Venkateswara Rao T, Jaisankar G, Venkateswara Rao V. A study on saltwater intrusion around Kolleru Lake, Andhra Pradesh, India. International Journal of Engineering and Technology (IJET). 2012;4(3):133-139

Delineation of Salt Water and Fresh Water Interface between Kolleru Lake and Bay of Bengal… DOI: http://dx.doi.org/10.5772/intechopen.90448

[15] ESRI. Getting to Know ArcGIS. Redlands: ESRI Press; 2001

References

Salt in the Earth

2012;4(3):133-139

251-257

89(3):217-228

388(1–2):100-111

42(5):671-677

2(2):1-7

14

[1] Harikrishna K, RamprasadNaik D, VenkateswaraRao T, Jaisankar G, VenkateswaraRao V. A study on

coastal aquifers by joint inversion of DC and TEM soundings 3 cases histories. Ground Water. 2001;39(1):87-97

[8] World Health Organization (WHO). Guidelines for Drinking Water Quality. 3rd ed. Geneva, Switzerland. London:

[9] Beuro of Indian Standards for Drinking water (BIS); Drinking Water — Specification (Second Revision),

[10] Griffiths DH, Barker RD. Twodimensional resistivity imaging and modelling in areas of complex geology. Journal of Applied Geophysics. 1993;29

[11] Selvam S, Sivasubramaniam P. Groundwater potential zone

identification using geoelectrical survey: A case study from Medak district, Andhra Pradesh, India. International Journal of Geomatics and Geosciences.

[12] Oyedele KF, Ogagarue DO, Esse O. Groundwater potential evaluation using surface geophysics at Oru-Imope, South-Western Nigeria. European Journal of Scientific Research. 2011;

[13] Griffiths E. Soil structure. In: A System for Description and Interpretation for Permeability

District Office Report HV14,

(IJET). 2012;4(3):133-139

Assessment. New Zealand: Soil Bureau

Department of Scientific and Industrial

[14] Hari krishna K, Ramprasad Naik D, Venkateswara Rao T, Jaisankar G, Venkateswara Rao V. A study on saltwater intrusion around Kolleru Lake, Andhra Pradesh, India. International Journal of Engineering and Technology

IWA Publishing; 2008

New Delhi: BIS; 2012

(3–4):211-226

2012;3(1):55-62

63(4):515-522

Research; 1986

saltwater intrusion around Kolleru Lake, Andhra Pradesh, India. International Journal of Engineering and Technology.

[2] Harikrishna K, VenkateswaraRao V,

RamprasadNaik D, Jaisankar G, Amminedu E. Hydrogeological & Geophysical studies for delineation of

freshwater source in the paleo beach ridges around Kolleru Lake, Andhra Pradesh. International Journal on Emerging Trends in Technology (IJETT). 2013a;4(3):

[3] Narayan KA, Schleeberger C,

North Queensland, Australia.

[4] Mondal C, Singh P, Singh S, Saxena K. Determining the interaction between saline water and groundwater through groundwater major ions chemistry. Journal of Hydrology. 2010;

[5] Kalpan C, Saha DK. Integrated geophysical and chemical study of saline water intrusion. Ground Water. 2004;

[6] Harikrishna K, Appala Raju G, Venkateswara Rao V, Jaisankar G, Amminedu E. Land use/land cover patterns in and around Kolleru lake, Andhra Pradesh, India using RS and GIS techniques. nternational Journal of Remote Sensing and Geosciences. 2013;

[7] Albouy Y, Andrieux P, Rakotondrasoa G, Ritz M,

Descloitres M, Join L, et al. Mapping

Bristow C. Modelling seawater intrusion in the Burdekin Delta irrigation area,

Agricultural Water Management. 2007;

[16] Bonham Carter GF. Geographic Information System for Geoscientists: Modeling with GIS. The Boulevare, Langford Lane, Kidlington, OX5 1GB, U.K.: Elsevier Science Ltd.; 2002

**17**

Section 2

Salt Intake in Human Life

Section 2

## Salt Intake in Human Life

**19**

**Chapter 2**

**Abstract**

replace salt in food.

**1. Introduction**

civilisations.

salt reduction, salt substitutes, history of salt

Human Health

*and Maria Eduarda Potes*

The Role of Salt on Food and

*Miguel Elias, Marta Laranjo, Ana Cristina Agulheiro-Santos* 

Throughout time, salt (sodium chloride) played an important role in human societies. In ancient times, salt was used as a form of currency and to preserve foods, such as meat and fish. Besides, salt also assumed a major importance as food flavour enhancer. However, excessive salt consumption could result in serious health problems, related with hypertension and cardiovascular diseases, although this might be a controversial topic in the near future. The World Health Organization has made several policy recommendations to reduce salt intake and even implemented some policy approaches in several countries worldwide. Nevertheless, according to the European Food Safety Authority, approximately 75% of the salt we eat is already in the foods we buy. Thus, the best way to assure an effective reduction in salt consumption is to train our taste to the flavour of low-salt foods, although there is still a long way to go from awareness to action. The main goal of this chapter is to review the social and economic importance of salt throughout human history; its role in food preservation, food safety and food sensory evaluation; the impact of salt intake on human health; and the attempts to reduce or

**Keywords:** sodium chloride, food safety, flavour, cardiovascular diseases,

Salt, also known as table salt or sodium chloride, is an ionic compound with the

Therefore, salt was known as the "white gold", although several other commodities, such as sugar, cotton, marbles, ivory and water, also received that designation [1–9]. Salt was such an important commodity throughout world history that the word *salary* is linked to how wages were once paid in salt. Furthermore, the origins of the

In the centuries prior to the invention of electricity and refrigeration, salt was primarily used to preserve food. It was also a key ingredient in the curing of leather [1].

chemical formula NaCl, representing a 1:1 ratio of sodium and chloride ions. The meekest of seasonings, table salt is commonly used as a condiment and food preservative. However, it was a precious commodity that played an important part in the development of the ancient world. For most of human history, salt was considered an extremely valuable commodity, as valuable as gold among ancient

word *soldier* are also related to someone who was paid in salt [1].

#### **Chapter 2**

## The Role of Salt on Food and Human Health

*Miguel Elias, Marta Laranjo, Ana Cristina Agulheiro-Santos and Maria Eduarda Potes*

#### **Abstract**

Throughout time, salt (sodium chloride) played an important role in human societies. In ancient times, salt was used as a form of currency and to preserve foods, such as meat and fish. Besides, salt also assumed a major importance as food flavour enhancer. However, excessive salt consumption could result in serious health problems, related with hypertension and cardiovascular diseases, although this might be a controversial topic in the near future. The World Health Organization has made several policy recommendations to reduce salt intake and even implemented some policy approaches in several countries worldwide. Nevertheless, according to the European Food Safety Authority, approximately 75% of the salt we eat is already in the foods we buy. Thus, the best way to assure an effective reduction in salt consumption is to train our taste to the flavour of low-salt foods, although there is still a long way to go from awareness to action. The main goal of this chapter is to review the social and economic importance of salt throughout human history; its role in food preservation, food safety and food sensory evaluation; the impact of salt intake on human health; and the attempts to reduce or replace salt in food.

**Keywords:** sodium chloride, food safety, flavour, cardiovascular diseases, salt reduction, salt substitutes, history of salt

#### **1. Introduction**

Salt, also known as table salt or sodium chloride, is an ionic compound with the chemical formula NaCl, representing a 1:1 ratio of sodium and chloride ions.

The meekest of seasonings, table salt is commonly used as a condiment and food preservative. However, it was a precious commodity that played an important part in the development of the ancient world. For most of human history, salt was considered an extremely valuable commodity, as valuable as gold among ancient civilisations.

Therefore, salt was known as the "white gold", although several other commodities, such as sugar, cotton, marbles, ivory and water, also received that designation [1–9].

Salt was such an important commodity throughout world history that the word *salary* is linked to how wages were once paid in salt. Furthermore, the origins of the word *soldier* are also related to someone who was paid in salt [1].

In the centuries prior to the invention of electricity and refrigeration, salt was primarily used to preserve food. It was also a key ingredient in the curing of leather [1].

#### *Salt in the Earth*

Salt has had the same economic importance as oil throughout most of human history. Therefore, in ancient times countries built their salt reserves before they went to war, so that enough food could be preserved for the forces being sent into battle [1].

Besides, salt was often taxed by nations and empires in the course of history. During the French Revolution, in regions where salt was scarce, it was worth up to 20 times more than in salt-producing regions. The death penalty was applied for smuggling salt! In India in 1930, the "salt tax" essentially made it illegal to sell or produce salt in competition with the established British monopoly on salt production. The quest for salt also played a crucial role in several battles in the American Civil War. For example, salt workers were exempt from being drafted into the army [1].

Currently, table salt, namely, sodium chloride (NaCl), is important in foods mainly due to its role on sensory appreciation, processing technology and preservation.

According to the European Food Safety Authority (EFSA), approximately 75% of the salt we eat is already in the foods we buy [10].

Nowadays, there is a growing concern with making foods nutritionally more balanced. Therefore, with the purpose of developing healthier foods, food reformulation is underway and comprises the modification of food composition by reducing or replacing ingredients, such as salt, fat and sugar [11]. In fact, recent studies have suggested that the biggest reductions in salt consumption were achieved by comprehensive strategies, such as food reformulation and media campaigns, associated to food policies, namely, regulations, taxation, mandatory reformulations and food labelling, while individual interventions on consumer education and dietary counselling have almost no effect [12, 13].

Despite the clear implications of excessive salt consumption for public health, moving from consumer awareness to action still seems to be a huge step to take [14]. Nevertheless, the adaptation to a less salty taste by consumers can be an important way to reduce salt content in food products [15–18]. Therefore, distinct strategies to implement salt reduction initiatives in different countries and among different target populations are needed [13].

#### **2. The role of salt in food preservation**

Salt is well-known for its role as flavouring agent and as food preservative both in industrial food processing and home cooking. Nevertheless, salt shows different technological properties in food production.

Dehydration was the earliest curing process, and, in order to preserve foods during dehydration, early civilizations salted foods to help desiccate them. Nowadays, this practice is still used.

Salt acts as a preservative by reducing the availability of water in foods, thereby depriving microorganisms from using available water as a nutrient [19, 20] and decreasing enzymatic activity [20]. The growth of pathogens and spoilage microorganisms is avoided or delayed in the presence of salt [20]. *Clostridium perfringens* and *Clostridium botulinum* are severely inhibited by salt, but *Staphylococcus aureus* and *Listeria monocytogenes* are relatively halotolerant [21].

Salt can be added to food products to assist in reducing and preventing microbial growth [22, 23]. This may be achieved either due to the bacteriostatic role of salt [24] or because of its ability to regulate enzyme activity [24], for example, through its influence on the growth of fermenting bacteria [20]. The main mechanisms responsible for the inhibition of microorganisms by salt include cellular plasmolysis, inhibited respiration, o-nitrophenyl-β-galactoside hydrolysis, glucose utilisation, prevention of substrate transport into the cells across cell membranes, limiting oxygen solubility and interference with enzymes [21]. Furthermore, sodium

**21**

*The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*

anchovies, among others [27].

ences the fermentation rate.

protein structure.

ture cheeses.

catalytic activities and by altering their cofactors [25].

**3. The technological role of salt in food production**

meat and improves the binding of batters in processed meats.

essential nutrient needed by the body in small amounts.

loss. This is very important, for example, in processed meats.

the milk proteinase and microbial enzymes [30].

characteristics of foods [31].

**3.1 Meat and meat products**

influences the growth of bacteria involved in fermentation processes [20]. Salt plays several main roles in the processing of different foods [23]:

Canned foods—It can be used for cleaning fish, before canning.

chloride may decrease enzymatic activity by denaturing enzymes, by reducing their

Salt can help to extend the shelf life of cured meat products, such as dry-cured ham, bacon and ham [26] or canned fish, namely, sardines, tuna, mackerel or

Nowadays, the functional properties of salt in food processing and food production go well beyond taste. In fact, salt plays different technological roles in food production. Besides flavour, it has an important role also in safety and on textural properties. It also

Meat and meat products—It increases the water-holding capacity, tenderises raw

Salt not only gives foods a "salty" flavour, but it can also enhance other flavours, such as aromatic notes. It balances sweetness and helps suppress flavours, such as bitterness. Salt or better sodium chloride can also be a nutrient source for sodium, an

Salt also plays a role as texture enhancer. It modifies the structure of proteins and modifies the interaction of proteins with other components, such as water and fat, which impacts the texture of foods. For example, if the proper amount of salt is added, cheese can have more body, meat can be juicier, and fish and breads can be firmer. According to Akkerman et al. [28], low-salt cheeses were found to be less firm and more compressible. Moreover, Jian-Qiang et al. [29] studied mozzarella cheese and reported that salt content had influence on the meltability of no-salted imma-

Salt is also important as a binding and emulsifying agent. The new protein structure helps to hold the product together and helps to prevent moisture and fat

The gelling ability of food proteins is an important functional attribute for food manufacturing. The food industry uses different proteins to produce gels or gel-containing products which exhibit various rheological properties, appearance and gel point. Gelation is a basic process in the processing of various foods, namely, meat and other meat products, bread and bakery doughs, dairy products and fish products, among others. Salt, sugar and fat, included in the formulations of most food products, modify the properties gels, affecting the rheological and textural

Salt is undoubtedly the most ancient known ingredient, performing numerous functions in meat. Its addition to sausages' meat batters is mainly due to its activity in reducing water activity (aW), functioning as bacteriostatic, controlling the growth of

NaCl has a main role in cheese manufacturing, namely, regulating the coagulant,

Bread—It makes gluten more stable and less extensible and sticky, and it influ-

Cheese—It modulates the microbiota, regulating the activity of starters and modifying enzyme activities, and it affects the cheese's body/texture by altering

#### *The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*

*Salt in the Earth*

Salt has had the same economic importance as oil throughout most of human history. Therefore, in ancient times countries built their salt reserves before they went to war, so that enough food could be preserved for the forces being sent into battle [1]. Besides, salt was often taxed by nations and empires in the course of history. During the French Revolution, in regions where salt was scarce, it was worth up to 20 times more than in salt-producing regions. The death penalty was applied for smuggling salt! In India in 1930, the "salt tax" essentially made it illegal to sell or produce salt in competition with the established British monopoly on salt production. The quest for salt also played a crucial role in several battles in the American Civil War. For example, salt workers were exempt from being drafted into the army [1]. Currently, table salt, namely, sodium chloride (NaCl), is important in foods mainly

due to its role on sensory appreciation, processing technology and preservation.

of the salt we eat is already in the foods we buy [10].

counselling have almost no effect [12, 13].

**2. The role of salt in food preservation**

technological properties in food production.

and *Listeria monocytogenes* are relatively halotolerant [21].

target populations are needed [13].

this practice is still used.

According to the European Food Safety Authority (EFSA), approximately 75%

Nowadays, there is a growing concern with making foods nutritionally more balanced. Therefore, with the purpose of developing healthier foods, food reformulation is underway and comprises the modification of food composition by reducing or replacing ingredients, such as salt, fat and sugar [11]. In fact, recent studies have suggested that the biggest reductions in salt consumption were achieved by comprehensive strategies, such as food reformulation and media campaigns, associated to food policies, namely, regulations, taxation, mandatory reformulations and food labelling, while individual interventions on consumer education and dietary

Despite the clear implications of excessive salt consumption for public health, moving from consumer awareness to action still seems to be a huge step to take [14]. Nevertheless, the adaptation to a less salty taste by consumers can be an important way to reduce salt content in food products [15–18]. Therefore, distinct strategies to implement salt reduction initiatives in different countries and among different

Salt is well-known for its role as flavouring agent and as food preservative both in industrial food processing and home cooking. Nevertheless, salt shows different

Dehydration was the earliest curing process, and, in order to preserve foods during dehydration, early civilizations salted foods to help desiccate them. Nowadays,

Salt acts as a preservative by reducing the availability of water in foods, thereby depriving microorganisms from using available water as a nutrient [19, 20] and decreasing enzymatic activity [20]. The growth of pathogens and spoilage microorganisms is avoided or delayed in the presence of salt [20]. *Clostridium perfringens* and *Clostridium botulinum* are severely inhibited by salt, but *Staphylococcus aureus*

Salt can be added to food products to assist in reducing and preventing microbial growth [22, 23]. This may be achieved either due to the bacteriostatic role of salt [24] or because of its ability to regulate enzyme activity [24], for example, through its influence on the growth of fermenting bacteria [20]. The main mechanisms responsible for the inhibition of microorganisms by salt include cellular plasmolysis, inhibited respiration, o-nitrophenyl-β-galactoside hydrolysis, glucose utilisation, prevention of substrate transport into the cells across cell membranes, limiting

oxygen solubility and interference with enzymes [21]. Furthermore, sodium

**20**

chloride may decrease enzymatic activity by denaturing enzymes, by reducing their catalytic activities and by altering their cofactors [25].

Salt can help to extend the shelf life of cured meat products, such as dry-cured ham, bacon and ham [26] or canned fish, namely, sardines, tuna, mackerel or anchovies, among others [27].

#### **3. The technological role of salt in food production**

Nowadays, the functional properties of salt in food processing and food production go well beyond taste. In fact, salt plays different technological roles in food production. Besides flavour, it has an important role also in safety and on textural properties. It also influences the growth of bacteria involved in fermentation processes [20].

Salt plays several main roles in the processing of different foods [23]:

Meat and meat products—It increases the water-holding capacity, tenderises raw meat and improves the binding of batters in processed meats.

Bread—It makes gluten more stable and less extensible and sticky, and it influences the fermentation rate.

Cheese—It modulates the microbiota, regulating the activity of starters and modifying enzyme activities, and it affects the cheese's body/texture by altering protein structure.

Canned foods—It can be used for cleaning fish, before canning.

Salt not only gives foods a "salty" flavour, but it can also enhance other flavours, such as aromatic notes. It balances sweetness and helps suppress flavours, such as bitterness.

Salt or better sodium chloride can also be a nutrient source for sodium, an essential nutrient needed by the body in small amounts.

Salt also plays a role as texture enhancer. It modifies the structure of proteins and modifies the interaction of proteins with other components, such as water and fat, which impacts the texture of foods. For example, if the proper amount of salt is added, cheese can have more body, meat can be juicier, and fish and breads can be firmer.

According to Akkerman et al. [28], low-salt cheeses were found to be less firm and more compressible. Moreover, Jian-Qiang et al. [29] studied mozzarella cheese and reported that salt content had influence on the meltability of no-salted immature cheeses.

Salt is also important as a binding and emulsifying agent. The new protein structure helps to hold the product together and helps to prevent moisture and fat loss. This is very important, for example, in processed meats.

NaCl has a main role in cheese manufacturing, namely, regulating the coagulant, the milk proteinase and microbial enzymes [30].

The gelling ability of food proteins is an important functional attribute for food manufacturing. The food industry uses different proteins to produce gels or gel-containing products which exhibit various rheological properties, appearance and gel point. Gelation is a basic process in the processing of various foods, namely, meat and other meat products, bread and bakery doughs, dairy products and fish products, among others. Salt, sugar and fat, included in the formulations of most food products, modify the properties gels, affecting the rheological and textural characteristics of foods [31].

#### **3.1 Meat and meat products**

Salt is undoubtedly the most ancient known ingredient, performing numerous functions in meat. Its addition to sausages' meat batters is mainly due to its activity in reducing water activity (aW), functioning as bacteriostatic, controlling the growth of pathogenic microorganisms [32]. However, salt has many other effects of unquestionable interest. Salt promotes flavour and diminishes pH, which, due to the Donnan effect [33, 34], causes a decrease in the isoelectric point of proteins and consequently a higher water-holding ability.

Goutefongea [34] mentions that for salt concentrations of 10%, most saltsensitive bacterial forms are inhibited, while salt concentrations of 5% only inhibit anaerobic forms. More recently, due to demands related to consumer preferences, the salt concentrations used in meat products in the countries that are more aware of consumers' health does not exceed 3% [35]. However, in many other countries, such as Portugal, salt contents close to 6% are still found in traditional sausages, although there is a growing concern to reduce salt.

Salt is also added to some meat and meat products to influence water-holding capacity and give the products a moister texture [36]. Ionic strength, which is influenced by salt content, has a strong influence in gel formation. The use of approximately 2–3% sodium chloride in meat products is necessary to solubilise myofibrillar proteins [32, 36]. Therefore, salt improves texture.

Salt can also help to enhance flavour and colour [37, 38]. It can affect the final flavour through the control of the biochemical and enzymatic reactions throughout ripening [39].

#### **3.2 Bread and bakery products**

Salt is very important for the bakery industry because it can make dough texture a little stronger and tighter. Furthermore, it has an impact in the shelf life of baked goods, because it reduces water activity.

The main function of salt in bread is to bring out the good flavours and mask the off-flavours. Usage levels are usually around 2%. Legislation may vary from country to country because the intake of too much salt is considered as a health risk.

Salt helps slow down chemical reactions, including controlling the fermentation rate of yeast and dough development. Salt helps control yeast activity and strengthens the protein matrix that forms the crumb structure of the bread. It is, therefore, of utmost importance that the salt is completely dissolved in doughs. In addition to impacting flavour, salt also inhibits fermentation due to the osmotic pressure effect. Yeast cells will partially dehydrate due to the osmotic pressure. The effect of salt on fermentation can be used to control the fermentation process: salt can be added, for instance, to sponges to slow down the fermentation rate. Slowing down fermentation rate means that less sugars are metabolised into acids. The result is that the pH of the dough will be higher, and the crust colour will be darker. Salt also influences enzyme activity. Additionally, salt toughens the gluten; it has a conditioning effect on the dough. Weaker flours could be strengthened by adding salt. It can be used to improve the handling properties of the dough by reducing the stickiness. Even though it strengthens the gluten, it delays its formation during mixing. Salt lengthens the mixing time, so it is common to delay the addition of the salt to the mixer. Faster flour hydration is also seen with delayed salt. The reason why salt toughens the gluten must be sought in the fact that gluten is made of negatively charged proteins. Negatively charged molecules will repel and not attract each other. It is believed that the positive sodium ions (Na<sup>+</sup> ) of salt play a role in bringing the protein molecules closer to each other. Finally, bread with no salt will also has a crust which is lighter in colour (given the same baking time and oven temperature). This can be explained as follows. Salt will slow down fermentation, so when there is no salt, the yeast activity will increase, i.e. the yeast will metabolise more sugar in the same amount of time. As a result, there will be less sugars left in the dough, and the pH of the dough will be lower (more acids will be formed). Sugars play (together

**23**

*The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*

**3.3 Other food products**

colour and flavour [47].

odour [50].

microbial growth.

are less sugars left, the colour of the crust is lighter [42].

age and preventing the growth of pathogens [43].

preservation other hurdles are used as well [46].

giving the final product distinct characteristics [49].

plays an important role, since it decreases aW [51].

softening agent but also in the fermentation process [48].

purposes but also as a texturing and emulsifying agent [54].

a texture and flavour enhancing function in crackers.

with proteins, moisture and heat) an important role in the Maillard reaction [40]. This reaction is a chemical and nonenzymatic browning reaction between an amino acid or a protein with a free amino group and a reducing sugar during the thermal processing and storage of foods [41]. In this reaction melanoidins are intermediate compounds, which are responsible for the resulting brown colour [40, 41]. However, the Maillard reaction is also influenced by pH: a higher pH will speed up the Maillard reaction. Therefore, in the case where the pH is lower and where there

Salt and milk proteins interact to provide an essential water-binding function. Furthermore, salt acts as a flavour enhancer and preservative in cheeses. In fact, salt has three major functions in cheese: it acts as a preservative, contributes directly to flavour and is a source of dietary sodium. Together with the desired pH, water activity and redox potential, salt assists in cheese preservation by minimising spoil-

Seafood products or fishery and shellfish products include all wild or farmed seawater or freshwater fish, crustaceans, molluscs and surimi, whether fresh, frozen, cooked, salted, dried, smoked, fermented and marinated, as well as sushi [44, 45]. Fish and shellfish have been acknowledged for being high-protein, low-calorie foods rich in essential polyunsaturated fatty acids. They are also considered a valuable source of minerals and vitamins. However, they are quite perishable, mainly due to their intrinsic composition and habitat. This fact has contributed to the development and improvement of seafood preserving methods since ancient times [46]. Nowadays, salt is still used for seafood preservation, mainly in developing countries, although most salted fish and shellfish products are lightly salted, and for

Salt favours lipid oxidation, accelerating rancidity and consequently affecting

Salting is a process used in the preservation of several fish products, such as salted cod, sea bream, chub mackerel and smoked salmon, among others [48].

Traditionally ripened herring is a protected product in Denmark. Beheaded herrings are put in plastic barrels with salt, sugar and some spices and kept for 36 months under refrigeration. This salting/ripening process is important mainly to produce a well-ripened product with a tender consistency and a pleasant taste and

In the preparation of smoked fish products, such as smoked salmon, salt also

The major five dietary sources of sodium in the USA are ready-to-eat (RTE) foods, namely, bread and rolls, meat products, pizza, poultry and soups [52].

Flavour enhancement is one of the primary functions of salt in processed and ready-to-eat foods. Moreover, salt is one of the tools used for preservation to control

In the processing of vegetable products, salt can be used as a preservative and/or

Salt plays a role in the flavour of cereals and other snack foods [53] and provides

In sauces, such as mayonnaise, and dressings, salt is used for preservation

Cod (*Gadus morhua* L.) is a white fish traditionally commercialised as salted cod in Mediterranean countries. Different salting methods may be used for cod salting,

#### *The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*

with proteins, moisture and heat) an important role in the Maillard reaction [40]. This reaction is a chemical and nonenzymatic browning reaction between an amino acid or a protein with a free amino group and a reducing sugar during the thermal processing and storage of foods [41]. In this reaction melanoidins are intermediate compounds, which are responsible for the resulting brown colour [40, 41]. However, the Maillard reaction is also influenced by pH: a higher pH will speed up the Maillard reaction. Therefore, in the case where the pH is lower and where there are less sugars left, the colour of the crust is lighter [42].

#### **3.3 Other food products**

*Salt in the Earth*

ripening [39].

**3.2 Bread and bakery products**

goods, because it reduces water activity.

believed that the positive sodium ions (Na<sup>+</sup>

a higher water-holding ability.

although there is a growing concern to reduce salt.

myofibrillar proteins [32, 36]. Therefore, salt improves texture.

pathogenic microorganisms [32]. However, salt has many other effects of unquestionable interest. Salt promotes flavour and diminishes pH, which, due to the Donnan effect [33, 34], causes a decrease in the isoelectric point of proteins and consequently

Goutefongea [34] mentions that for salt concentrations of 10%, most saltsensitive bacterial forms are inhibited, while salt concentrations of 5% only inhibit anaerobic forms. More recently, due to demands related to consumer preferences, the salt concentrations used in meat products in the countries that are more aware of consumers' health does not exceed 3% [35]. However, in many other countries, such as Portugal, salt contents close to 6% are still found in traditional sausages,

Salt is also added to some meat and meat products to influence water-holding capacity and give the products a moister texture [36]. Ionic strength, which is influenced by salt content, has a strong influence in gel formation. The use of approximately 2–3% sodium chloride in meat products is necessary to solubilise

Salt can also help to enhance flavour and colour [37, 38]. It can affect the final flavour through the control of the biochemical and enzymatic reactions throughout

Salt is very important for the bakery industry because it can make dough texture a little stronger and tighter. Furthermore, it has an impact in the shelf life of baked

The main function of salt in bread is to bring out the good flavours and mask the off-flavours. Usage levels are usually around 2%. Legislation may vary from country

Salt helps slow down chemical reactions, including controlling the fermentation rate of yeast and dough development. Salt helps control yeast activity and strengthens the protein matrix that forms the crumb structure of the bread. It is, therefore, of utmost importance that the salt is completely dissolved in doughs. In addition to impacting flavour, salt also inhibits fermentation due to the osmotic pressure effect. Yeast cells will partially dehydrate due to the osmotic pressure. The effect of salt on fermentation can be used to control the fermentation process: salt can be added, for instance, to sponges to slow down the fermentation rate. Slowing down fermentation rate means that less sugars are metabolised into acids. The result is that the pH of the dough will be higher, and the crust colour will be darker. Salt also influences enzyme activity. Additionally, salt toughens the gluten; it has a conditioning effect on the dough. Weaker flours could be strengthened by adding salt. It can be used to improve the handling properties of the dough by reducing the stickiness. Even though it strengthens the gluten, it delays its formation during mixing. Salt lengthens the mixing time, so it is common to delay the addition of the salt to the mixer. Faster flour hydration is also seen with delayed salt. The reason why salt toughens the gluten must be sought in the fact that gluten is made of negatively charged proteins. Negatively charged molecules will repel and not attract each other. It is

tein molecules closer to each other. Finally, bread with no salt will also has a crust which is lighter in colour (given the same baking time and oven temperature). This can be explained as follows. Salt will slow down fermentation, so when there is no salt, the yeast activity will increase, i.e. the yeast will metabolise more sugar in the same amount of time. As a result, there will be less sugars left in the dough, and the pH of the dough will be lower (more acids will be formed). Sugars play (together

) of salt play a role in bringing the pro-

to country because the intake of too much salt is considered as a health risk.

**22**

Salt and milk proteins interact to provide an essential water-binding function. Furthermore, salt acts as a flavour enhancer and preservative in cheeses. In fact, salt has three major functions in cheese: it acts as a preservative, contributes directly to flavour and is a source of dietary sodium. Together with the desired pH, water activity and redox potential, salt assists in cheese preservation by minimising spoilage and preventing the growth of pathogens [43].

Seafood products or fishery and shellfish products include all wild or farmed seawater or freshwater fish, crustaceans, molluscs and surimi, whether fresh, frozen, cooked, salted, dried, smoked, fermented and marinated, as well as sushi [44, 45].

Fish and shellfish have been acknowledged for being high-protein, low-calorie foods rich in essential polyunsaturated fatty acids. They are also considered a valuable source of minerals and vitamins. However, they are quite perishable, mainly due to their intrinsic composition and habitat. This fact has contributed to the development and improvement of seafood preserving methods since ancient times [46].

Nowadays, salt is still used for seafood preservation, mainly in developing countries, although most salted fish and shellfish products are lightly salted, and for preservation other hurdles are used as well [46].

Salt favours lipid oxidation, accelerating rancidity and consequently affecting colour and flavour [47].

Salting is a process used in the preservation of several fish products, such as salted cod, sea bream, chub mackerel and smoked salmon, among others [48].

Cod (*Gadus morhua* L.) is a white fish traditionally commercialised as salted cod in Mediterranean countries. Different salting methods may be used for cod salting, giving the final product distinct characteristics [49].

Traditionally ripened herring is a protected product in Denmark. Beheaded herrings are put in plastic barrels with salt, sugar and some spices and kept for 36 months under refrigeration. This salting/ripening process is important mainly to produce a well-ripened product with a tender consistency and a pleasant taste and odour [50].

In the preparation of smoked fish products, such as smoked salmon, salt also plays an important role, since it decreases aW [51].

The major five dietary sources of sodium in the USA are ready-to-eat (RTE) foods, namely, bread and rolls, meat products, pizza, poultry and soups [52].

Flavour enhancement is one of the primary functions of salt in processed and ready-to-eat foods. Moreover, salt is one of the tools used for preservation to control microbial growth.

In the processing of vegetable products, salt can be used as a preservative and/or softening agent but also in the fermentation process [48].

Salt plays a role in the flavour of cereals and other snack foods [53] and provides a texture and flavour enhancing function in crackers.

In sauces, such as mayonnaise, and dressings, salt is used for preservation purposes but also as a texturing and emulsifying agent [54].

Ready-to-eat shrimp, due to its processing, cooking in salted water, is also an RTE food with a high-salt, high-sodium content.

In canned foods, salt is added mainly to preserve the product.

#### **4. Salt consumption and human health**

Despite all the health problems associated to salt consumption, its excessive use is constantly growing. Ninety-five percent of the world's population in 2013 presented a mean salt intake between 6 and 12 g/day [55], and even nowadays the average of 9–12 g per day is pointed out by the World Health Organization (WHO). Many changes are necessary to reduce salt intake and achieve the necessary reduction in high blood pressure. All the WHO member states assumed the compromise of reducing by 30% the salt intake in their populations until 2025, estimating that 2.5 million deaths can be prevented with the adequate salt consumption [56].

In fact, hypertension, which constitutes one of the risk factors for cardiovascular disease, particularly coronary heart disease and stroke, is highly correlated with the excessive consumption of salt in the human diet [57]. On the other hand, hypertension has been associated with high intakes of sodium through the sodium chloride (NaCl) used in food. Still, sodium is important for distinct physiological functions and is essential for cellular homeostasis [58].

The WHO recommends that adults consume less than 5 g (just under a teaspoon) of salt per day [56].

This mineral is essential for human health to maintain plasma volume, regulating body water content and electrolyte balance, transmission of nerve impulses and normal cell function; however, its excess in human diet leads to high blood pressure. This problem is often correlated with high consumption of sugar and fat, besides salt.

However, a decrease in potassium intake and an unhealthy lifestyle are responsible for the increased numbers of noncommunicable diseases (NCDs). NCDs, also known as chronic diseases, result from a combination of genetic, physiological, environmental and behavioural factors and are generally prolonged in duration [12, 59]. The main types of NCDs are cardiovascular diseases (like heart attacks and strokes), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and type 2 diabetes [59]. The "Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020" include a 30% relative reduction in the intake of salt by 2025.

According to the WHO (2018), NCDs are the cause of 41 million deaths of people each year, being cardiovascular diseases the first cause of death. Cardiovascular disease is the leading cause of death in the USA [60].

The trials that studied the role of salt in the blood pressure begun with the studies in rats of Goldblatt [61]. Some years later, Kempner [62] stated for the first time that high salt could induce hypertension and low salt could lower blood pressure. This was followed by a huge number of clinical studies about sodium restriction to control blood pressure. The result of numerous trials along the years pointed out the importance of a diet with low income of salt to decrease blood pressure. Sacks et al. [63], in a meta-analysis of 31 trials, obtained a decrease of 5.0 mmHg of systolic and 2.7 mmHg diastolic blood pressure because of a decrease of 4 g of salt per day (which corresponds to sodium 75 mmol/day) in hypertensive patients.

However, nowadays, some researchers criticise these evidences referring that most trials evaluated high blood pressure, malnourished and mainly aged patients [64]. So, according to McCarron et al. [65] and Graudal and Jürgens [66], the

**25**

saltier [47].

CaCl2 or MgCl2 [36].

*The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*

institutions and their policies.

health priority [14].

proposed salt daily intake for healthy people (normal blood pressure), and even the evidence of its negative role on blood pressure, should be reconsidered by health

Another aspect to be considered in human health is the necessity to evaluate jointly low sodium and high potassium intake, because high potassium consumption has a beneficial effect in preventing hypertension [67]. Potassium is present mainly in fruits, vegetables and unrefined foods and is essential for regulating fluid balance and controlling the electrical activity of the heart and other muscles and maintains normal cell function. Increased potassium intake reduced blood pressure, and it can mitigate the negative effects of elevated sodium consumption on blood pressure [68]. The WHO suggests a potassium intake of at least 3510 mg/day for adults.

The food reformulation, concerning modification in food composition with the development of healthier products, and at the same time consumer acceptance, is one strategy to achieve sodium reduction and a better intake of potassium in the human diet. Some countries, in Europe, published legislation for food reformulation by setting maximum levels for certain food components or by defining health targets. The National Salt Reduction Initiatives, developed in 2009, has the goal of

Some recent findings indicate that human sodium intake is controlled by physi-

If the consumption of high levels of sodium (table salt contains 38.1% sodium) has been associated with hypertension, much effort has been spent on the complete or partial replacement of table salt (sodium chloride). It is not the salt as such, which is the culprit, but the sodium in the salt. Therefore, when discussing salt

Strategies on how to reduce salt content in food products without depreciating their quality have been proposed by several institutional and health-related organisations that recommend cooking with little or no added salt, valorising the natural taste of foods. The strategies may include, among others, seasoning with aromatic herbs, spices, lemon juice, wine and vinegar; use of marinades and garlic vines to season foods the day before; combining tasteless foods with foods of more intense flavour, such as onion, garlic, pepper and tomato; cooking with low amounts of water, to concentrate aroma and flavours; no addition of salt if the meal contains preprepared sauces, sausages or canned food; avoiding adding more salt while cook-

Salt reduction can further be achieved in three main ways: replacement of sodium chloride by potassium chloride, addition of a flavour enhancer that enhances the salty taste even with lower salt contents and changing the physical structure of sodium chloride so that its crystals dissolve faster in the mouth, tasting

The most popular approach in reducing sodium chloride (NaCl) in the formulation of food products is to replace it with other chloride salts such as KCl, LiCl,

Potassium chloride (KCl) has been used as the main alternative to NaCl in salt replacement experiments, mostly because its antimicrobial effectiveness has been

Nevertheless, the reduction of the dietary salt intake remains a global public

reaching the maximum recommended intake of 5 g salt all over Europe.

ology and cannot be modified by public health policies [65].

**5. Salt reduction and replacement studies**

reduction, one must consider all sources of sodium.

ing; and not putting the salt shaker on the table.

reported to be similar to that of NaCl [80].

Plain salt reduction studies are shown in **Table 1**.

#### *The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*

*Salt in the Earth*

Ready-to-eat shrimp, due to its processing, cooking in salted water, is also an

Despite all the health problems associated to salt consumption, its excessive use is constantly growing. Ninety-five percent of the world's population in 2013 presented a mean salt intake between 6 and 12 g/day [55], and even nowadays the average of 9–12 g per day is pointed out by the World Health Organization (WHO). Many changes are necessary to reduce salt intake and achieve the necessary reduction in high blood pressure. All the WHO member states assumed the compromise of reducing by 30% the salt intake in their populations until 2025, estimating that 2.5 million deaths can be prevented with the adequate salt consumption [56].

In fact, hypertension, which constitutes one of the risk factors for cardiovascular disease, particularly coronary heart disease and stroke, is highly correlated with the excessive consumption of salt in the human diet [57]. On the other hand, hypertension has been associated with high intakes of sodium through the sodium chloride (NaCl) used in food. Still, sodium is important for distinct physiological functions

The WHO recommends that adults consume less than 5 g (just under a tea-

This mineral is essential for human health to maintain plasma volume, regulating body water content and electrolyte balance, transmission of nerve impulses and normal cell function; however, its excess in human diet leads to high blood pressure. This problem is often correlated with high consumption of sugar and fat,

However, a decrease in potassium intake and an unhealthy lifestyle are responsible for the increased numbers of noncommunicable diseases (NCDs). NCDs, also known as chronic diseases, result from a combination of genetic, physiological, environmental and behavioural factors and are generally prolonged in duration [12, 59]. The main types of NCDs are cardiovascular diseases (like heart attacks and strokes), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and type 2 diabetes [59]. The "Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020" include a 30%

According to the WHO (2018), NCDs are the cause of 41 million deaths of people each year, being cardiovascular diseases the first cause of death. Cardiovascular

The trials that studied the role of salt in the blood pressure begun with the studies in rats of Goldblatt [61]. Some years later, Kempner [62] stated for the first time that high salt could induce hypertension and low salt could lower blood pressure. This was followed by a huge number of clinical studies about sodium restriction to control blood pressure. The result of numerous trials along the years pointed out the importance of a diet with low income of salt to decrease blood pressure. Sacks et al. [63], in a meta-analysis of 31 trials, obtained a decrease of 5.0 mmHg of systolic and 2.7 mmHg diastolic blood pressure because of a decrease of 4 g of salt per day (which corresponds to sodium 75 mmol/day) in

However, nowadays, some researchers criticise these evidences referring that most trials evaluated high blood pressure, malnourished and mainly aged patients [64]. So, according to McCarron et al. [65] and Graudal and Jürgens [66], the

In canned foods, salt is added mainly to preserve the product.

RTE food with a high-salt, high-sodium content.

**4. Salt consumption and human health**

and is essential for cellular homeostasis [58].

relative reduction in the intake of salt by 2025.

disease is the leading cause of death in the USA [60].

spoon) of salt per day [56].

besides salt.

**24**

hypertensive patients.

proposed salt daily intake for healthy people (normal blood pressure), and even the evidence of its negative role on blood pressure, should be reconsidered by health institutions and their policies.

Another aspect to be considered in human health is the necessity to evaluate jointly low sodium and high potassium intake, because high potassium consumption has a beneficial effect in preventing hypertension [67]. Potassium is present mainly in fruits, vegetables and unrefined foods and is essential for regulating fluid balance and controlling the electrical activity of the heart and other muscles and maintains normal cell function. Increased potassium intake reduced blood pressure, and it can mitigate the negative effects of elevated sodium consumption on blood pressure [68]. The WHO suggests a potassium intake of at least 3510 mg/day for adults.

The food reformulation, concerning modification in food composition with the development of healthier products, and at the same time consumer acceptance, is one strategy to achieve sodium reduction and a better intake of potassium in the human diet. Some countries, in Europe, published legislation for food reformulation by setting maximum levels for certain food components or by defining health targets. The National Salt Reduction Initiatives, developed in 2009, has the goal of reaching the maximum recommended intake of 5 g salt all over Europe.

Some recent findings indicate that human sodium intake is controlled by physiology and cannot be modified by public health policies [65].

Nevertheless, the reduction of the dietary salt intake remains a global public health priority [14].

#### **5. Salt reduction and replacement studies**

If the consumption of high levels of sodium (table salt contains 38.1% sodium) has been associated with hypertension, much effort has been spent on the complete or partial replacement of table salt (sodium chloride). It is not the salt as such, which is the culprit, but the sodium in the salt. Therefore, when discussing salt reduction, one must consider all sources of sodium.

Strategies on how to reduce salt content in food products without depreciating their quality have been proposed by several institutional and health-related organisations that recommend cooking with little or no added salt, valorising the natural taste of foods. The strategies may include, among others, seasoning with aromatic herbs, spices, lemon juice, wine and vinegar; use of marinades and garlic vines to season foods the day before; combining tasteless foods with foods of more intense flavour, such as onion, garlic, pepper and tomato; cooking with low amounts of water, to concentrate aroma and flavours; no addition of salt if the meal contains preprepared sauces, sausages or canned food; avoiding adding more salt while cooking; and not putting the salt shaker on the table.

Plain salt reduction studies are shown in **Table 1**.

Salt reduction can further be achieved in three main ways: replacement of sodium chloride by potassium chloride, addition of a flavour enhancer that enhances the salty taste even with lower salt contents and changing the physical structure of sodium chloride so that its crystals dissolve faster in the mouth, tasting saltier [47].

The most popular approach in reducing sodium chloride (NaCl) in the formulation of food products is to replace it with other chloride salts such as KCl, LiCl, CaCl2 or MgCl2 [36].

Potassium chloride (KCl) has been used as the main alternative to NaCl in salt replacement experiments, mostly because its antimicrobial effectiveness has been reported to be similar to that of NaCl [80].


#### **Table 1.**

*Salt reduction studies in different food products.*

The effect on consumer acceptance or consumer perception of low-salt foods has been evaluated, and these studies should precede the development of new products by the food industry [81].

**Table 2** summarises some recent studies on salt replacement, considering different food products.

As it can be seen from **Table 2**, there are numerous salt replacement studies on bread and meat products, whereas only a few on other foods.

Regarding bread and other bakery products, potassium chloride has a lower inhibiting effect on the yeast. Furthermore, proofing and mixing times are shorter. Moreover, potassium chloride is more difficult to dissolve in water than sodium chloride. Hence, it is important to choose "fine" potassium chloride and not a coarse grade. The undissolved grains will cause dark brown spots on the crust of the product. Still, KCl showed characteristics similar to NaCl in baked products. However, other salt replacers, such as magnesium chloride, ammonium chloride, magnesium sulphate or calcium chloride, have limited application due to their more unpleasant flavour [97].

Aromatic and medicinal plants (AMP) can also be used as flavouring agents, giving a tastier flavour to foods and thus enabling salt reduction [98]. Herbs or AMP, namely, oregano, basil, marjoram, thyme and bay leaf, added to fresh soups, reduced the need for salt intake when the perceived herb flavour increased [87]. Spices have also been added to dried fish goldstripe sardinella (*Sardinella gibbosa*) to reduce the amount of added salt [78].

*Salicornia* sp. is a wild food plant with long history of human consumption that has been used in traditional vegetable mixtures in Italy [99] and is known for its salty taste and high nutritional values [100].

**27**

*The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*

**5.1 Meat and meat products**

*Salt replacement studies in different food products.*

30% or by glycine at levels 50%.

phosphates [101].

**Table 2.**

with 2.73% NaCl.

Several studies have reported the reduction of salt content in meat products and its partial replacement with other salts, such as potassium chloride (KCl), magnesium chloride (MgCl), lithium chloride (LiCl), calcium chloride (CaCl2) and

**Food product Salt substitute Reference** Cooked ham KCl [76] Dry-fermented sausages KCl [82] Fermented sausages KCl/potassium lactate/glycine [83] Dry-cured pork loin KCl/potassium lactate/glycine [83] Dry-fermented sausages Calcium ascorbate [84] Pork sausage patties KCl [85] Dry-fermented sausages KCl/CaCl2 [86] Fresh and canned soups Herbs [87] Bread KCl/yeast extract [88] Bread CaCl2/CaCO3 [89] Wheat bread KCl/MgCl2/CaCl2 [90] Brown bread Calcium carbonate/MgSO4/MgCl2/KCl [91] Cheddar-style cheese KCl/MgCl2/CaCl2 [92] Mozzarella cheese KCl [93] Pizza crust KCl [52] White bread CaCl2/MgCl2/KCl/MgSO4 [94] Fermented sausages KCl [95] Dry-cured loins KCl [96] Slow-fermented sausages KCl [15] Cooked ham KCl [76]

However, concerning dry-cured meat sausages, it is more difficult to develop low-salt traditional products. Sodium chloride has a determinant effect both in

Gou et al. [83] used potassium chloride, potassium lactate and glycerine as partial substitutes for sodium chloride in the formulation of fermented sausages. However, major defects were found regarding aroma and flavour when these salts replaced more 40% of the sodium chloride content. These authors also found changes in texture when the NaCl was replaced by potassium lactate at levels above

Ibáñez et al. [82] detected the development of nitrosamines and the heterofermentative activity of carbohydrates by starter cultures were favoured by a mixture of 1.37% NaCl and 0.92% KCl, when compared to the same sausages manufactured

Other studies have shown a sensory depreciation in sausages with 1% NaCl, 0.55% KCl, 0.23% MgCl2 and 0.46% CaCl2, when compared to sausages with 2.6% NaCl [84]. A significant reduction in the sodium content of Spanish sausages was

flavour as in the microbiological stability of sausages.

#### *The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*


#### **Table 2.**

*Salt in the Earth*

sausages

Traditional blood dry-cured

by the food industry [81].

*Salt reduction studies in different food products.*

ent food products.

**Table 1.**

flavour [97].

reduce the amount of added salt [78].

salty taste and high nutritional values [100].

The effect on consumer acceptance or consumer perception of low-salt foods has been evaluated, and these studies should precede the development of new products

**Food product Salt content Reference Control (%) Low salt (%)**

"*Catalão*" and "*Salsichão*" 6.0 3.0 [70] Hotdog sausages 3.6 2.8/2.0 [71] Bacon 4.3 3.4/2.3 [71] Ham 3.1 2.4/1.7 [71] Salami 11.7 9.8/6.3 [71] Bread 2.0 1.8/1.61/1.38 [72] Cottage cheese cream 2.2 1.48/0.73 [73] Pizza crust 1.09 1.02/0.99/0.91/0.84/0.76/0.51 [52] Cheddar cheese 1.8–2.1 1.25/0.50 [74] Prato cheese 1.68 1.23 [75] Cooked ham 1.9 1.33/0.95/0.00 [76] Soup 0.3/0.2/0.1 0.21/0.14/0.07 [77] Dried fish 10 5 [78] Durum wheat bread 2.0 1.5/1.0 [79] "*Painho de Portalegre*" 6.0 3.0/2.0 This study

6.0 3.0 [69]

**Table 2** summarises some recent studies on salt replacement, considering differ-

As it can be seen from **Table 2**, there are numerous salt replacement studies on

Regarding bread and other bakery products, potassium chloride has a lower inhibiting effect on the yeast. Furthermore, proofing and mixing times are shorter. Moreover, potassium chloride is more difficult to dissolve in water than sodium chloride. Hence, it is important to choose "fine" potassium chloride and not a coarse grade. The undissolved grains will cause dark brown spots on the crust of the product. Still, KCl showed characteristics similar to NaCl in baked products. However, other salt replacers, such as magnesium chloride, ammonium chloride, magnesium sulphate or calcium chloride, have limited application due to their more unpleasant

Aromatic and medicinal plants (AMP) can also be used as flavouring agents, giving a tastier flavour to foods and thus enabling salt reduction [98]. Herbs or AMP, namely, oregano, basil, marjoram, thyme and bay leaf, added to fresh soups, reduced the need for salt intake when the perceived herb flavour increased [87]. Spices have also been added to dried fish goldstripe sardinella (*Sardinella gibbosa*) to

*Salicornia* sp. is a wild food plant with long history of human consumption that has been used in traditional vegetable mixtures in Italy [99] and is known for its

bread and meat products, whereas only a few on other foods.

**26**

*Salt replacement studies in different food products.*

#### **5.1 Meat and meat products**

Several studies have reported the reduction of salt content in meat products and its partial replacement with other salts, such as potassium chloride (KCl), magnesium chloride (MgCl), lithium chloride (LiCl), calcium chloride (CaCl2) and phosphates [101].

However, concerning dry-cured meat sausages, it is more difficult to develop low-salt traditional products. Sodium chloride has a determinant effect both in flavour as in the microbiological stability of sausages.

Gou et al. [83] used potassium chloride, potassium lactate and glycerine as partial substitutes for sodium chloride in the formulation of fermented sausages. However, major defects were found regarding aroma and flavour when these salts replaced more 40% of the sodium chloride content. These authors also found changes in texture when the NaCl was replaced by potassium lactate at levels above 30% or by glycine at levels 50%.

Ibáñez et al. [82] detected the development of nitrosamines and the heterofermentative activity of carbohydrates by starter cultures were favoured by a mixture of 1.37% NaCl and 0.92% KCl, when compared to the same sausages manufactured with 2.73% NaCl.

Other studies have shown a sensory depreciation in sausages with 1% NaCl, 0.55% KCl, 0.23% MgCl2 and 0.46% CaCl2, when compared to sausages with 2.6% NaCl [84]. A significant reduction in the sodium content of Spanish sausages was


#### **Table 3.**

*Microbiological analyses of traditional Portuguese dry-fermented sausages (Painho de Portalegre) with low-salt content.*

achieved by the partial replacement of NaCl by different percentages of calcium ascorbate [86]. However, these sausages showed worse results for colour and texture when compared with control sausages.

Regarding microbiological parameters, no unwanted changes were noticed with the replacements of NaCl by other salts, in all the above-mentioned studies. From a sensory point of view, the major advantage of these sausages seems to be the insufficient salty flavour.

In a study regarding the microbiological, physicochemical, biochemical and sensory characteristics of traditional sausages from Alentejo, Portugal (*Painho de Portalegre*), instead of replacing NaCl, the authors reduced its content to 3% in the final product. The influence of salt content (2 or 3% NaCl in the final product) on the microbiota and the rheological and sensory properties of sausages were evaluated, and the results are shown in **Table 3**.

The number of mesophiles did not vary significantly, although the sausages with 3% NaCl have slightly higher counts. These results seem to indicate that the natural microbiota of these sausages is characteristically halotolerant. This is even more evident for yeasts. On the other hand, the counts of enterobacteria and enterococci are higher in 2% NaCl sausages. Considering that these microbiological groups are associated with the hygiene conditions of the manufacturing process, the bacteriostatic role of salt was beneficial. As for the technological microbiota [102, 103], the lactic acid bacteria, still present in high numbers in the final product, which is characteristic in this kind of sausage, almost do not vary with the sodium chloride concentration. Interestingly, Gram-positive, catalase-positive cocci (GCC+) show higher counts in the 2% sausages, although they usually grow well in the presence of salt [104]. The counts of all other microbial groups did not vary with salt content.

Regarding sensory analysis (**Table 4**), sausages with 2% NaCl showed higher colour intensity values, but 3% NaCl sausages were tender (confirmed by the rheological tests), more succulent and with higher flavour intensity. The results obtained for these two last attributes may be because salt stimulates salivation and potentiates the flavour of foods. Concerning global appreciation, there was a slight preference for the sausages with less salt.

Generally, the microbiota of these sausages did not vary with salt content. Furthermore, concerning sensory analysis, no significant differences were observed

**29**

sausages [105].

**Table 4.**

*content.*

advantages [70].

*The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*

*Data are expressed as means ± standard deviation.*

for any of the studied attributes. Furthermore, the rheological analysis showed no

*Sensory analysis of traditional Portuguese dry-fermented sausages (Painho de Portalegre) with low-salt* 

**Sensory attributes Salt content (% NaCl)**

Colour intensity 75.6 ± 9.3 61.8 ± 18.2 Aroma intensity 69.4 ± 12.3 65.0 ± 8.8 Tenderness 65.0 ± 16.6 74.6 ± 14.5 Fibrousness 31.4 ± 22.1 29.8 ± 19.9 Succulence 66.75 ± 9.7 70.0 ± 10.0 Flavour intensity 67.6 ± 10.5 72.2 ± 5.3 Off-flavours 5.2 ± 8.4 8.0 ± 13.0 Salt intensity 56.0 ± 9.0 64.0 ± 11.4 Global appreciation 71.2 ± 11.2 69.0 ± 6.5

**2% 3%**

Furthermore, the production of *Painho de Portalegre* is characterised by a different formulation regarding salt content. These may significantly influence the qualitative and quantitative formation of biogenic amines, since they modulate the microbiota throughout the manufacturing process. Thus, regarding the profile in biogenic amines, differences were detected between the two salt concentrations. In another study with *Painho de Portalegre*, the effect of salt in the profile of biogenic amines was evaluated. Differences were observed between the two salt concentrations in the final product, 3 and 6% NaCl (data not shown). The content in biogenic amines, mainly cadaverine, putrescine, tyramine and β-phenylethylamine,

Several other studies on traditional Portuguese sausages have shown the neutral

Sensory evaluations revealed that despite the less intense aroma, products with 3% salt had a more balanced salt perception. Our results suggest that salt content may be reduced to 50% in dry-cured products, with the obvious health-related

The reduction in salt content from 6 to 2% in large calibre pork sausages did not compromise safety nor depreciate the sensory acceptability of the products [106]. Coutron-Gambotti et al. [107] studied the effect of salt reduction on the lipidic composition and sensory attributes of dry-cured ham and observed a reduction in the number of autoxidation processes and a consequent improvement of aroma and flavour. Regarding rheological analysis, salt content did not significantly influence the textural characteristics of the sausages, namely, hardness, cohesiveness, elastic-

Regarding consumer acceptance studies, low-salt small calibre fermented sausages with a NaCl/KCl 50:50 ratio were found to be acceptable for consumers [95]. Moreover, dry-cured loins also with a 50:50 ratio NaCl/KCl obtained the highest

Salt reduction does not negatively affect the quality and acceptability of

was severely reduced in 6% NaCl sausages throughout the curing period.

Low-salt sausages were clearly preferred by panellists [69].

influence of salt content in the studied attributes.

or positive effect of salt reduction on these products.

ity, gumminess, chewiness and shear force.

scores in sensory evaluation by a trained panel [96].

#### *The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*


#### **Table 4.**

*Salt in the Earth*

achieved by the partial replacement of NaCl by different percentages of calcium ascorbate [86]. However, these sausages showed worse results for colour and texture

*Microbiological analyses of traditional Portuguese dry-fermented sausages (Painho de Portalegre) with low-salt content.*

**Microbiological groups (cfu/g) Salt content (% NaCl)**

Total mesophiles 7.44 7.93 Total psychrotrophic microorganisms 7.25 7.85 Yeasts 2.60 4.28 Moulds n.d. n.d. Gram-positive, catalase-positive cocci (GCC+) 6.59 5.38 Lactic acid bacteria (LAB) 8.46 8.41 Enterobacteria 3.21 2.90 Enterococci 5.86 5.66 Spores of aerobic bacteria\* 3.11 3.98

**2% 3%**

Regarding microbiological parameters, no unwanted changes were noticed with the replacements of NaCl by other salts, in all the above-mentioned studies. From a sensory point of view, the major advantage of these sausages seems to be the insuf-

In a study regarding the microbiological, physicochemical, biochemical and sensory characteristics of traditional sausages from Alentejo, Portugal (*Painho de Portalegre*), instead of replacing NaCl, the authors reduced its content to 3% in the final product. The influence of salt content (2 or 3% NaCl in the final product) on the microbiota and the rheological and sensory properties of sausages were evalu-

The number of mesophiles did not vary significantly, although the sausages with 3% NaCl have slightly higher counts. These results seem to indicate that the natural microbiota of these sausages is characteristically halotolerant. This is even more evident for yeasts. On the other hand, the counts of enterobacteria and enterococci are higher in 2% NaCl sausages. Considering that these microbiological groups are associated with the hygiene conditions of the manufacturing process, the bacteriostatic role of salt was beneficial. As for the technological microbiota [102, 103], the lactic acid bacteria, still present in high numbers in the final product, which is characteristic in this kind of sausage, almost do not vary with the sodium chloride concentration. Interestingly, Gram-positive, catalase-positive cocci (GCC+) show higher counts in the 2% sausages, although they usually grow well in the presence of salt [104]. The counts of all other microbial groups did not vary with salt content. Regarding sensory analysis (**Table 4**), sausages with 2% NaCl showed higher colour intensity values, but 3% NaCl sausages were tender (confirmed by the rheological tests), more succulent and with higher flavour intensity. The results obtained for these two last attributes may be because salt stimulates salivation and potentiates the flavour of foods. Concerning global appreciation, there was a slight

Generally, the microbiota of these sausages did not vary with salt content. Furthermore, concerning sensory analysis, no significant differences were observed

when compared with control sausages.

ated, and the results are shown in **Table 3**.

preference for the sausages with less salt.

ficient salty flavour.

*n.d., none detected*

**Table 3.**

*\*Expressed in number of spores/g.*

**28**

*Sensory analysis of traditional Portuguese dry-fermented sausages (Painho de Portalegre) with low-salt content.*

for any of the studied attributes. Furthermore, the rheological analysis showed no influence of salt content in the studied attributes.

Furthermore, the production of *Painho de Portalegre* is characterised by a different formulation regarding salt content. These may significantly influence the qualitative and quantitative formation of biogenic amines, since they modulate the microbiota throughout the manufacturing process. Thus, regarding the profile in biogenic amines, differences were detected between the two salt concentrations.

In another study with *Painho de Portalegre*, the effect of salt in the profile of biogenic amines was evaluated. Differences were observed between the two salt concentrations in the final product, 3 and 6% NaCl (data not shown). The content in biogenic amines, mainly cadaverine, putrescine, tyramine and β-phenylethylamine, was severely reduced in 6% NaCl sausages throughout the curing period.

Several other studies on traditional Portuguese sausages have shown the neutral or positive effect of salt reduction on these products.

Salt reduction does not negatively affect the quality and acceptability of sausages [105].

Sensory evaluations revealed that despite the less intense aroma, products with 3% salt had a more balanced salt perception. Our results suggest that salt content may be reduced to 50% in dry-cured products, with the obvious health-related advantages [70].

Low-salt sausages were clearly preferred by panellists [69].

The reduction in salt content from 6 to 2% in large calibre pork sausages did not compromise safety nor depreciate the sensory acceptability of the products [106].

Coutron-Gambotti et al. [107] studied the effect of salt reduction on the lipidic composition and sensory attributes of dry-cured ham and observed a reduction in the number of autoxidation processes and a consequent improvement of aroma and flavour. Regarding rheological analysis, salt content did not significantly influence the textural characteristics of the sausages, namely, hardness, cohesiveness, elasticity, gumminess, chewiness and shear force.

Regarding consumer acceptance studies, low-salt small calibre fermented sausages with a NaCl/KCl 50:50 ratio were found to be acceptable for consumers [95]. Moreover, dry-cured loins also with a 50:50 ratio NaCl/KCl obtained the highest scores in sensory evaluation by a trained panel [96].

#### *Salt in the Earth*

Tamm and co-workers [76] produced low-salt cooked hams (30% reduction) without significant differences in water binding and texture compared to regularsalt hams, by combining the use of a high isostatic pressure treatment with the partial replacement of NaCl by KCl.

#### **5.2 Bread and bakery products**

Bread is a major contributor to sodium intake. Therefore, a reduction in the salt content of bread would cause a great impact on global health.

Recently, there has been quite some pressure on the bakery sector to reduce the salt content in bread, cakes and muffins, among others. Potassium chloride has been regarded as an acceptable substitute for sodium chloride as it has basically the same rheological effects on the dough. However, if sodium chloride is replaced by the same amount of potassium chloride, the bread will have a bitter aftertaste. This is only a problem in bread; it does not occur in products such as muffins or cakes, because this aftertaste mostly disappears after 2 or 3 days and it can be masked using eggs and butter.

Reduction of salt in bread involves changes in quality characteristics, such as flavour, shelf life and texture. Besides, the manufacturing process is affected by changes in dough stickiness [40]. The replacement of NaCl by KCl does not have any significant processing disadvantages but has a negative impact on flavour [40].

Several studies have evaluated the acceptable replacement levels of NaCl by KCl in bread [108, 109].

#### **5.3 Other food products**

Strategies for reducing "salt" in cheese include mainly the reduction of table salt (NaCl) and its replacement by potassium chloride (KCl). However, these strategies present many challenges, such as adverse effects on flavour, microbiological stability and functional properties of the final product. When salt content is simply reduced in natural cheese, proteolysis, water activity, acidity and bitterness all increase, while hardness decreases. In addition, irregular fermentations could occur which may alter the desired characteristic taste of the cheese, namely, the development of a bitter unacceptable flavour.

In cheddar cheese, which has been extensively studied with respect to salt reduction, analysis showed that reducing NaCl resulted in an unpleasant aftertaste and bitterness. Within a range of 0.5–3% salt, at salt levels below 1.5% compared to higher levels of 1.8–3%, an increase in the growth of undesired non-starter bacteria occurred that caused bitter flavours due to excessive proteolysis [74].

The reduction and/or replacement of sodium chloride (NaCl) by potassium chloride (KCl) in cheese is a difficult task that may affect the global desired quality of the cheese. It depends, among other factors, on the type of cheese. The different manufacturing processes make it easier to reduce or replace table salt in processed cheeses than in natural or soft cheeses [110].

The reduction of salt levels in cheese can be done over a period of time, to prevent the consumer from detecting organoleptic changes [111].

NaCl reduction in cottage cheese cream dressing is possible from a mechanical or rheological point of view, without significantly changing the sensory acceptability of the product [73].

**31**

*The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*

depreciating their sensory evaluation [52].

reformulating of food products [13].

**6. World policy, particularly in the European Union**

these foods.

prepared meals.

salted codfish, crackers and industrial sauces, are responsible for most of the salt consumed. Therefore, when cooking and eating at home, consumers should avoid

Potential effect of salt reduction in processed foods has been reviewed [112]. Pizza is a major contributor to the daily sodium intake [52]. Mueller and coworkers prepared pizza crusts with reduced sodium contents of up to 25%, without

Ready-to-eat foods to take away or served in restaurants also contribute immensely to the salt intake of the modern consumer. Ahuja and colleagues [60] reviewed the subject and emphasised the importance of public health efforts together with food manufacturers and restaurants to reduce the sodium levels in

The WHO has made several policy recommendations to reduce salt intake, restrict or eliminate choice, guide choice through (dis)incentives, enable or guide choice through changing default (reformulation and marketing), restrict or eliminate choice, provide information (public health campaigns and labelling) and monitor. These may be combined to effectively reduce salt consumption [113]. Likewise, some policy approaches have already been implemented, which mainly pursue the objectives: to provide information, to make the healthy option available or to provide financial (dis)incentives related to salt consumption [113]. Several governments from countries around the world have adopted national salt reduction strategies, which range from legal obligations, such as the limit of salt content in bread, to intended actions involving the food industry, mainly regarding

**Food product Country Salt level (%) Reference** Bread Austria 15% reduction [114] Bread Belgium <2% [114] Bread Bulgaria <1.2% [115] White cheese in brine Bulgaria <3.5 ± 0.5% [115] Yellow cheese "Kashkaval" Bulgaria 1.8–3.0% [115] Durable boiled smoked sausage Bulgaria ≤3.5% [115] "Lutenica"\* Bulgaria ≤1.7% [115] Bread Croatia 30% reduction in added salt [114] Bread Finland Low-salt threshold: 0.7% [114] Sausages Finland Low-salt threshold: 1.2% [114] Cheese Finland Low-salt threshold: 0.7% [114] Fish products Finland Low-salt threshold: 1% [114] Breakfast cereals Finland Low-salt threshold: 1% [114] Butter Finland Low-salt threshold: 1% [114] Soups Finland Low-salt threshold: 0.5% [114] Sauces Finland Low-salt threshold: 0.5% [114] Ready-made dishes Finland Low-salt threshold: 0.5% [114] Crisp bread Finland Low-salt threshold: 1.2% [114]

Processed foods, namely, those with a high salt content for preservation, such as pickles, smoked foods, concentrated broths and meat-based food, namely, patties, croquettes, sausages and ham, canned seafood, fish and meat, dried or

#### *The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*

*Salt in the Earth*

partial replacement of NaCl by KCl.

**5.2 Bread and bakery products**

using eggs and butter.

on flavour [40].

in bread [108, 109].

**5.3 Other food products**

ment of a bitter unacceptable flavour.

cheeses than in natural or soft cheeses [110].

Tamm and co-workers [76] produced low-salt cooked hams (30% reduction) without significant differences in water binding and texture compared to regularsalt hams, by combining the use of a high isostatic pressure treatment with the

Bread is a major contributor to sodium intake. Therefore, a reduction in the salt

Recently, there has been quite some pressure on the bakery sector to reduce the salt content in bread, cakes and muffins, among others. Potassium chloride has been regarded as an acceptable substitute for sodium chloride as it has basically the same rheological effects on the dough. However, if sodium chloride is replaced by the same amount of potassium chloride, the bread will have a bitter aftertaste. This is only a problem in bread; it does not occur in products such as muffins or cakes, because this aftertaste mostly disappears after 2 or 3 days and it can be masked

Reduction of salt in bread involves changes in quality characteristics, such as flavour, shelf life and texture. Besides, the manufacturing process is affected by changes in dough stickiness [40]. The replacement of NaCl by KCl does not have any significant processing disadvantages but has a negative impact

Several studies have evaluated the acceptable replacement levels of NaCl by KCl

Strategies for reducing "salt" in cheese include mainly the reduction of table salt (NaCl) and its replacement by potassium chloride (KCl). However, these strategies present many challenges, such as adverse effects on flavour, microbiological stability and functional properties of the final product. When salt content is simply reduced in natural cheese, proteolysis, water activity, acidity and bitterness all increase, while hardness decreases. In addition, irregular fermentations could occur which may alter the desired characteristic taste of the cheese, namely, the develop-

In cheddar cheese, which has been extensively studied with respect to salt reduction, analysis showed that reducing NaCl resulted in an unpleasant aftertaste and bitterness. Within a range of 0.5–3% salt, at salt levels below 1.5% compared to higher levels of 1.8–3%, an increase in the growth of undesired non-starter bacteria

The reduction and/or replacement of sodium chloride (NaCl) by potassium chloride (KCl) in cheese is a difficult task that may affect the global desired quality of the cheese. It depends, among other factors, on the type of cheese. The different manufacturing processes make it easier to reduce or replace table salt in processed

The reduction of salt levels in cheese can be done over a period of time, to

NaCl reduction in cottage cheese cream dressing is possible from a mechanical or rheological point of view, without significantly changing the sensory acceptability

Processed foods, namely, those with a high salt content for preservation, such as pickles, smoked foods, concentrated broths and meat-based food, namely, patties, croquettes, sausages and ham, canned seafood, fish and meat, dried or

occurred that caused bitter flavours due to excessive proteolysis [74].

prevent the consumer from detecting organoleptic changes [111].

content of bread would cause a great impact on global health.

**30**

of the product [73].

salted codfish, crackers and industrial sauces, are responsible for most of the salt consumed. Therefore, when cooking and eating at home, consumers should avoid these foods.

Potential effect of salt reduction in processed foods has been reviewed [112].

Pizza is a major contributor to the daily sodium intake [52]. Mueller and coworkers prepared pizza crusts with reduced sodium contents of up to 25%, without depreciating their sensory evaluation [52].

Ready-to-eat foods to take away or served in restaurants also contribute immensely to the salt intake of the modern consumer. Ahuja and colleagues [60] reviewed the subject and emphasised the importance of public health efforts together with food manufacturers and restaurants to reduce the sodium levels in prepared meals.

#### **6. World policy, particularly in the European Union**

The WHO has made several policy recommendations to reduce salt intake, restrict or eliminate choice, guide choice through (dis)incentives, enable or guide choice through changing default (reformulation and marketing), restrict or eliminate choice, provide information (public health campaigns and labelling) and monitor. These may be combined to effectively reduce salt consumption [113].

Likewise, some policy approaches have already been implemented, which mainly pursue the objectives: to provide information, to make the healthy option available or to provide financial (dis)incentives related to salt consumption [113]. Several governments from countries around the world have adopted national salt reduction strategies, which range from legal obligations, such as the limit of salt content in bread, to intended actions involving the food industry, mainly regarding reformulating of food products [13].



**33**

*The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*

*\*Processed tomato and vegetable mixture; RT, room temperature.*

*Policy on salt reduction per food product in different countries.*

mainly to bread [60, 114–117].

world have been published previously [12, 13].

below 1.1 mg/kcal.

**Table 5.**

shown in **Table 5**.

**7. Conclusions**

matic activity.

In 2013, the salt reduction initiatives in the WHO European Region have been mapped and described by country [114]; however, the progression has been slow, and salt intake in most WHO European Region countries is far above the suggested amount [18]. Some countries adopted initiatives to reduce the total amount of salt consumed (maximum daily intake), others the amount of sodium, but only a few legislated the amount of salt added to food products and

Various food products USA "Healthy claim": <1.1 mg

**Food product Country Salt level (%) Reference** Mayonnaise Chile <1.05% sodium [116] Cookies and sweet biscuits Argentina <0.485% sodium [116] Cookies and sweet biscuits Brazil <0.485% sodium [116] Cookies and sweet biscuits Canada <0.485% sodium [116] Cookies and sweet biscuits UK <0.485% sodium [116] "Mozzarella" cheese Brazil <0.559% sodium [117]

sodium/kcal

[60]

In Portugal, an agreement was signed on May 2, 2019, between the *General Directorate of Health*, a central department of the Ministry of Health, and seven food industry and food distribution associations, to reduce the content in salt, sugar

In a study conducted in the USA with processed and restaurant foods, more than half of the analysed foods exceeded the US Food and Drug Administration's (FDA) sodium limit for using the claim "healthy" [60]. This "healthy" claim reports to the Healthy Eating Index-2010 [119] and to an optimal sodium level

Systematic reviews on salt reduction initiatives in different countries around the

A non-exhaustive summary of the current national initiatives per food product comparing policies between different countries, mainly of the European Union, is

Salt (sodium chloride) has played different but very important roles through-

out human history. It has been an important product, firstly for its action in food preservation and for its role as flavour enhancer. More recently, the effect of salt on some food components, namely, proteins, has also been recognised. In fact, salt modifies the structure of proteins and their interaction with other food components, which has consequences on the technological properties of those food products (meat and meat products, bread and other bakery products, cheese and other dairy products and canned fish products, among others). Regarding the technological role of salt, it also has an evident effect on microbial modulation, which is particularly important in fermented products and regulating the enzy-

and *trans* fats in over 2000 food products, for a healthier diet [118].

#### *The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*


#### **Table 5.**

*Salt in the Earth*

**Food product Country Salt level (%) Reference** Bread products Finland Heart symbol: <0.28% sodium [114] Bread Greece <1.5% [115] Tomato juice Greece <1% [115] Concentrated tomato puree paste Greece <4% [115] Biscuits Greece <0.5% sodium [115] Bread Hungary 16% reduction [114]

Bread and bakery Italy 10–15% reduction [114] Food served in schools Latvia <1.25 g salt/100 g [114] Food served to children Lithuania <0.4 mg sodium/100 g [114] Bread Netherlands <1.8% [114] Bread Portugal <1.4% [114] Food served in schools Romania <1.5% [115] Food served in schools Romania <0.6% sodium [115] Bread Spain 26.4% reduction [114] Bread UK <1.0–1.2% [115] Bread UK <0.6% sodium [116] Bread Turkey <1.4% [114] Bread Argentina <0.6% sodium [116] Bread Brazil <0.6% sodium [116] Bread Canada <0.6% sodium [116] Bread Chile <0.6% sodium [116] Soup Argentina <0.36% sodium [116] Soup Brazil <0.36% sodium [116] Soup Canada <0.36% sodium [116] Breakfast cereals Canada <0.63% sodium [116] Breakfast cereals Chile <0.63% sodium [116]

reduction

Argentina <1.21% sodium [116]

Brazil <1.21% sodium [116]

Canada <1.21% sodium [116]

Argentina <1.9% sodium [116]

Brazil <1.9% sodium [116]

Canada <1.9% sodium [116]

Mayonnaise Brazil <1.05% sodium [116] Mayonnaise Canada <1.05% sodium [116]

[114]

Various food products Ireland "Reduced salt" status: >25%

**32**

Cooked, uncooked, processed

Cooked, uncooked, processed

Cooked, uncooked, processed

Dry-cured meats and meats

Dry-cured meats and meats

Dry-cured meats and meats

meats/sausages

meats/sausages

meats/sausages

conserved at RT

conserved at RT

conserved at RT

*Policy on salt reduction per food product in different countries.*

In 2013, the salt reduction initiatives in the WHO European Region have been mapped and described by country [114]; however, the progression has been slow, and salt intake in most WHO European Region countries is far above the suggested amount [18]. Some countries adopted initiatives to reduce the total amount of salt consumed (maximum daily intake), others the amount of sodium, but only a few legislated the amount of salt added to food products and mainly to bread [60, 114–117].

In Portugal, an agreement was signed on May 2, 2019, between the *General Directorate of Health*, a central department of the Ministry of Health, and seven food industry and food distribution associations, to reduce the content in salt, sugar and *trans* fats in over 2000 food products, for a healthier diet [118].

In a study conducted in the USA with processed and restaurant foods, more than half of the analysed foods exceeded the US Food and Drug Administration's (FDA) sodium limit for using the claim "healthy" [60]. This "healthy" claim reports to the Healthy Eating Index-2010 [119] and to an optimal sodium level below 1.1 mg/kcal.

Systematic reviews on salt reduction initiatives in different countries around the world have been published previously [12, 13].

A non-exhaustive summary of the current national initiatives per food product comparing policies between different countries, mainly of the European Union, is shown in **Table 5**.

#### **7. Conclusions**

Salt (sodium chloride) has played different but very important roles throughout human history. It has been an important product, firstly for its action in food preservation and for its role as flavour enhancer. More recently, the effect of salt on some food components, namely, proteins, has also been recognised. In fact, salt modifies the structure of proteins and their interaction with other food components, which has consequences on the technological properties of those food products (meat and meat products, bread and other bakery products, cheese and other dairy products and canned fish products, among others). Regarding the technological role of salt, it also has an evident effect on microbial modulation, which is particularly important in fermented products and regulating the enzymatic activity.

This fundamental role of salt has been an obstacle to the reduction of its consumption, the latter being related to the occurrence of consumer health problems, namely, cardiovascular diseases. Adapting ourselves and training our taste to the flavour of low-salt food is undoubtedly the best way to assure the reduction of salt consumption. For the above-stated reasons, the WHO recommends a daily salt intake of 5 g per day for adults. Following these recommendations, several countries have implemented distinct measures to reduce the consumption of salt in different food products. Furthermore, numerous studies have been performed to find adequate alternatives to replace salt.

Nevertheless, some recent studies have unravelled that the negative effect of salt in human health has been systematically supported by trials, whose target groups were more susceptible to salt intake, such as hypertense, malnourished or elderly people. Therefore, new studies with healthy groups are needed. Moreover, there are recent studies that suggest the need to evaluate the intake of sodium and potassium comparatively, because potassium seems to have a beneficial effect in preventing hypertension, one of the predispositions for cardiovascular diseases. To cite Chris Kresser [120], it is important to question ourselves and "shake up the salt myth".

### **Acknowledgements**

This work was supported by national funds through *Fundação para a Ciência e a Tecnologia* (FCT)/MCTES under project UID/AGR/00115/2019 and through PT2020-PDR2020 co-funded through the European Agricultural Fund for Rural Development (EAFRD) under project PDR2020-1.0.1-FEADER-031373.

**35**

**Author details**

Miguel Elias1,2\*, Marta Laranjo1

Universidade de Évora, Évora, Portugal

provided the original work is properly cited.

\*Address all correspondence to: elias@uevora.pt

and Maria Eduarda Potes1,3

de Évora, Évora, Portugal

Évora, Évora, Portugal

, Ana Cristina Agulheiro-Santos1,2

1 ICAAM-Instituto de Ciências Agrárias e Ambientais Mediterrânicas, Universidade

2 Departamento de Fitotecnia, Escola de Ciências e Tecnologia, Universidade de

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

3 Departamento de Medicina Veterinária, Escola de Ciências e Tecnologia,

*The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*

### **Conflict of interest**

The authors declare that they have no conflict of interest.

*The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*

*Salt in the Earth*

salt myth".

**Acknowledgements**

**Conflict of interest**

adequate alternatives to replace salt.

This fundamental role of salt has been an obstacle to the reduction of its consumption, the latter being related to the occurrence of consumer health problems, namely, cardiovascular diseases. Adapting ourselves and training our taste to the flavour of low-salt food is undoubtedly the best way to assure the reduction of salt consumption. For the above-stated reasons, the WHO recommends a daily salt intake of 5 g per day for adults. Following these recommendations, several countries have implemented distinct measures to reduce the consumption of salt in different food products. Furthermore, numerous studies have been performed to find

Nevertheless, some recent studies have unravelled that the negative effect of salt in human health has been systematically supported by trials, whose target groups were more susceptible to salt intake, such as hypertense, malnourished or elderly people. Therefore, new studies with healthy groups are needed. Moreover, there are recent studies that suggest the need to evaluate the intake of sodium and potassium comparatively, because potassium seems to have a beneficial effect in preventing hypertension, one of the predispositions for cardiovascular diseases. To cite Chris Kresser [120], it is important to question ourselves and "shake up the

This work was supported by national funds through *Fundação para a Ciência e a Tecnologia* (FCT)/MCTES under project UID/AGR/00115/2019 and through PT2020-PDR2020 co-funded through the European Agricultural Fund for Rural

Development (EAFRD) under project PDR2020-1.0.1-FEADER-031373.

The authors declare that they have no conflict of interest.

**34**

### **Author details**

Miguel Elias1,2\*, Marta Laranjo1 , Ana Cristina Agulheiro-Santos1,2 and Maria Eduarda Potes1,3

1 ICAAM-Instituto de Ciências Agrárias e Ambientais Mediterrânicas, Universidade de Évora, Évora, Portugal

2 Departamento de Fitotecnia, Escola de Ciências e Tecnologia, Universidade de Évora, Évora, Portugal

3 Departamento de Medicina Veterinária, Escola de Ciências e Tecnologia, Universidade de Évora, Évora, Portugal

\*Address all correspondence to: elias@uevora.pt

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

### **References**

[1] Kurlansky M. Salt: A World History. New York, USA: Penguin Books; 2003. p. 496

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[3] Parsons JR. Salt: White gold of the ancient Maya. Antiquity. 2003;**77**: 425-426. DOI: 10.1017/ s0003598x00092462

[4] Pegeot P, Voisin JC. White gold and the fortune of salins + grande-saunerie, 15th-century salt industry. Histoire. 1985;**81**:85-87

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[7] Kepecs S. Salt: White gold of the ancient Maya. Ethnohistory. 2004;**51**:448-450. DOI: 10.1215/00141801-51-2-448

[8] Saile T. White gold: French and Romanian projects on salt in the extra-carpathian areas of Romania. Praehistorische Zeitschrift. 2017;**92**: 453-459. DOI: 10.1515/pz-2017-0020

[9] Pedrosa AG. The naval salt and salt mines: The white gold of somontano. Anuario de Estudios Medievales. 2017;**47**:933-934

[10] EFSA. Opinion of the scientific panel on dietetic products, nutrition and allergies on a request from the commission related to the tolerable upper intake level of sodium. EFSA Journal. 2005;**209**:1-26. DOI: 10.2903/j. efsa.2005.209

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**37**

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nfs.2015.03.001

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[19] Inguglia ES, Zhang Z, Tiwari BK, Kerry JP, Burgess CM. Salt reduction strategies in processed meat products—A review. Trends in Food Science and Technology. 2017;**59**:70-78. DOI: 10.1016/j.tifs.2016.10.016

[20] Inguglia ES, Kerry JP, Burgess CM, Tiwari BK. Salts and salt replacers. In: Melton L, Shahidi F, Varelis P, editors. Encyclopedia of Food Chemistry. Oxford: Academic Press; 2019. pp. 235-239

[21] Shelef LA, Seiter J. Indirect and miscellaneous antimicrobials. In: Davidson PM, Sofos JN, Branen AL, editors. Antimicrobials in Food. 3rd ed. Boca Raton, Florida, USA: CRC Press; 2005. pp. 573-598

[22] Grau R, Andres A, Barat JM. Principles of drying. In: Toldrá F, editor. Handbook of Fermented Meat and Poultry. 2nd ed. West Sussex, UK: Wiley-Blackwell; 2015. pp. 31-38

[23] Hutton T. Sodium technological functions of salt in the manufacturing of food and drink products. British Food Journal. 2002;**104**:126-152. DOI: 10.1108/00070700210423635

[24] Reig M, Armenteros M, Aristoy M-C, Toldrá F. Sodium replacers. In: Nollet LML, Toldrá F, editors. Handbook of Analysis of Active Compounds in Functional Foods. 1st ed. Boca Raton, USA: CRC Press; 2012. pp. 877-884

[25] Ravishankar S, Juneja VK. Preservatives: Traditional preservatives-sodium chloride. In: Batt CA, Tortorello ML, editors. Encyclopedia of Food Microbiology. 2nd ed. Oxford: Academic Press; 2014. pp. 131-136

[26] Pegg RB, Honikel KO. Principles of curing. In: Toldrá F, editor. Handbook

of Fermented Meat and Poultry. 2nd ed. West Sussex, UK: Wiley-Blackwell; 2015. pp. 19-30

[27] Featherstone S. 8 Ingredients used in the preparation of canned foods. In: Featherstone S, editor. A Complete Course in Canning and Related Processes. 14th ed. Oxford: Woodhead Publishing; 2015. pp. 147-211

[28] Akkerman M, Kristensen LS, Jespersen L, Ryssel MB, Mackie A, Larsen NN, et al. Interaction between sodium chloride and texture in semi-hard Danish cheese as affected by brining time, dl-starter culture, chymosin type and cheese ripening. International Dairy Journal. 2017;**70**: 34-45. DOI: 10.1016/j.idairyj.2016.10.011

[29] Jian-Qiang Z, Hao L, Chun B, Rongan C, Li-Ping Z. Effect of sodium chloride on meltability of mozzarella cheese. Journal of Northeast Agricultural University. 2014;**21**:68-75. DOI: 10.1016/S1006-8104(14)60071-4

[30] Guinee TP, O'Kennedy BT. Reducing salt in cheese and dairy spreads. In: Kilcast D, Angus F, editors. Reducing Salt in Foods: Practical Strategies. Boca Raton: CRC Press; 2007. pp. 316-357

[31] Zayas JF. Gelling properties of proteins. In: Zayas JF, editor. Functionality of Proteins in Food. Berlin, Heidelberg: Springer; 1997

[32] Ruusunen M, Puolanne E. Reducing sodium intake from meat products. Meat Science. 2005;**70**:531-541. DOI: 10.1016/j.meatsci.2004.07.016

[33] Möhler K. El Curado. Zaragoza, Spain: Editorial Acribia, S.A; 1984

[34] Goutefongea R. In: Girard JP, editor. Tecnologia de la Carne y de los Productos Cárnicos. Zaragoza, Spain: Editorial Acribia, S.A.; 1991

**36**

*Salt in the Earth*

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p. 496

2001;**28**:457-459

1985;**81**:85-87

425-426. DOI: 10.1017/ s0003598x00092462

[1] Kurlansky M. Salt: A World History. New York, USA: Penguin Books; 2003.

[11] Belc N, Smeu I, Macri A, Vallauri D, Flynn K. Reformulating foods to meet current scientific knowledge about salt, sugar and fats. Trends in Food Science and Technology. 2019;**84**:25-28. DOI:

[12] Hyseni L, Elliot-Green A, Lloyd-Williams F, Kypridemos C, O'Flaherty M, McGill R, et al. Systematic review of dietary salt reduction policies: Evidence for an effectiveness hierarchy? PLoS One. 2017;**12**:e0177535. DOI: 10.1371/

10.1016/j.tifs.2018.11.002

journal.pone.0177535

[13] Trieu K, Neal B, Hawkes C, Dunford E, Campbell N, Rodriguez-Fernandez R, et al. Salt reduction

10.1371/journal.pone.0130247

initiatives around the world—A systematic review of progress towards the global target. PLoS One. 2015;**10**:e0130247. DOI:

[14] Zandstra EH, Lion R, Newson RS. Salt reduction: Moving from consumer awareness to action. Food Quality and Preference. 2016;**48**:376-381. DOI: 10.1016/j.foodqual.2015.03.005

[15] Corral S, Salvador A, Flores M. Salt reduction in slow fermented sausages affects the generation of aroma active compounds. Meat Science.

[16] Drake SL, Lopetcharat K, Drake MA. Salty taste in dairy foods: Can we reduce the salt? Journal of Dairy Science. 2011;**94**:636-645. DOI: 10.3168/

[17] Ghawi SK, Rowland I, Methven L. Enhancing consumer liking of low salt tomato soup over repeated exposure by herb and spice seasonings. Appetite. 2014;**81**:20-29. DOI: 10.1016/j.

[18] Kloss L, Meyer JD, Graeve L, Vetter W. Sodium intake and its reduction by food reformulation in

2013;**93**:776-785

jds.2010-3509

appet.2014.05.029

[2] Brown IW. Salt: White gold of the Maya. Journal of Field Archaeology.

[3] Parsons JR. Salt: White gold of the ancient Maya. Antiquity. 2003;**77**:

[4] Pegeot P, Voisin JC. White gold and the fortune of salins + grande-saunerie, 15th-century salt industry. Histoire.

[5] Rochette ET. Salt: White gold of the ancient Maya. Latin American Antiquity. 2003;**14**:499-500. DOI: 10.2307/3557582

[6] Kennedy CM. The other white gold: Salt, slaves, the Turks and Caicos Islands, and British colonialism. The Historian. 2007;**69**:215-230. DOI: 10.1111/j.1540-6563.2007.00178.x

[7] Kepecs S. Salt: White gold of the ancient Maya. Ethnohistory.

[8] Saile T. White gold: French and Romanian projects on salt in the extra-carpathian areas of Romania. Praehistorische Zeitschrift. 2017;**92**: 453-459. DOI: 10.1515/pz-2017-0020

[9] Pedrosa AG. The naval salt and salt mines: The white gold of somontano. Anuario de Estudios Medievales.

[10] EFSA. Opinion of the scientific panel on dietetic products, nutrition and allergies on a request from the commission related to the tolerable upper intake level of sodium. EFSA Journal. 2005;**209**:1-26. DOI: 10.2903/j.

2004;**51**:448-450. DOI: 10.1215/00141801-51-2-448

2017;**47**:933-934

efsa.2005.209

[35] Lücke FK. Fermented sausages. In: Wood BJB, editor. Microbiology of Fermented Foods. 2nd ed. London, US: Springer; 1998. pp. 441-483

[36] Çarkcioğlu E, Rosenthal AJ, Candoğan K. Rheological and textural properties of sodium reduced salt soluble myofibrillar protein gels containing sodium tri-polyphosphate. Journal of Texture Studies. 2016;**47**:181- 187. DOI: 10.1111/jtxs.12169

[37] Flores M, Olivares A. Flavor. In: Toldrá F, editor. Handbook of Fermented Meat and Poultry. 2nd ed. West Sussex, UK: Wiley-Blackwell; 2015. pp. 217-225

[38] Møller JKS, Jongberg S, Skibsted LH. Color. In: Toldrá F, editor. Handbook of Fermented Meat and Poultry. 2nd ed. West Sussex, UK: Wiley-Blackwell; 2015. pp. 195-205

[39] Toldrá F. Proteolysis and lipolysis in flavour development of drycured meat products. Meat Science. 1998;**49**(Supplement 1):S101-S110. DOI: 10.1016/S0309-1740(98)90041-9

[40] Belz MCE, Ryan LAM, Arendt EK. The impact of salt reduction in bread: A review. Critical Reviews in Food Science and Nutrition. 2012;**52**:514-524. DOI: 10.1080/10408398.2010.502265

[41] Nooshkam M, Varidi M, Bashash M. The Maillard reaction products as foodborn antioxidant and antibrowning agents in model and real food systems. Food Chemistry. 2019;**275**:644-660. DOI: 10.1016/j.foodchem.2018.09.083

[42] Simsek S, Martinez MO. Quality of dough and bread prepared with sea salt or sodium chloride. Journal of Food Process Engineering. 2016;**39**: 44-52. DOI: 10.1111/jfpe.12197

[43] Guinee TP, Fox PF. Chapter 13— Salt in cheese: Physical, chemical and biological aspects. In: McSweeney PLH, Fox PF, Cotter PD, Everett DW, editors. Cheese. 4th ed. San Diego: Academic Press; 2017. pp. 317-375

[44] Brown A. Fish and shellfish. In: Understanding Food: Principles and Preparation. 6th ed. Boston, MA, USA: Cengage; 2019. pp. 165-186

[45] Ruethers T, Taki AC, Johnston EB, Nugraha R, Le TTK, Kalic T, et al. Seafood allergy: A comprehensive review of fish and shellfish allergens. Molecular Immunology. 2018;**100**:28-57. DOI: 10.1016/j.molimm.2018.04.008

[46] Pedro S, Nunes ML. Reducing salt in seafood products. In: Kilcast D, Angus F, editors. Reducing Salt in Foods: Practical Strategies. Boca Raton: CRC Press; 2007. pp. 256-282

[47] Mariutti LRB, Bragagnolo N. Influence of salt on lipid oxidation in meat and seafood products: A review. Food Research International. 2017;**94**:90-100. DOI: 10.1016/j. foodres.2017.02.003

[48] Albarracín W, Sánchez IC, Grau R, Barat JM. Salt in food processing; usage and reduction: A review. International Journal of Food Science and Technology. 2011;**46**:1329-1336. DOI: 10.1111/j.1365-2621.2010.02492.x

[49] Andrés A, Rodríguez-Barona S, Barat JM, Fito P. Salted cod manufacturing: Influence of salting procedure on process yield and product characteristics. Journal of Food Engineering. 2005;**69**:467-471. DOI: 10.1016/j.jfoodeng.2004.08.040

[50] Skåra T, Axelsson L, Stefánsson G, Ekstrand B, Hagen H. Fermented and ripened fish products in the northern European countries. Journal of Ethnic Foods. 2015;**2**:18-24. DOI: 10.1016/j. jef.2015.02.004

[51] Leroi F, Joffraud JJ, Chevalier F. Effect of salt and smoke on the

**39**

f1326

*The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*

> sodium and health: More than just blood pressure. Journal of the American College of Cardiology. 2015;**65**:1042- 1050. DOI: 10.1016/j.jacc.2014.12.039

[59] Fedacko J, Takahashi T, Singh RB, Pella D, Chibisov S, Hristova K, et al. Chapter 6—Globalization of diets and risk of noncommunicable diseases. In: Singh RB, Watson RR, Takahashi T, editors. The Role of Functional Food Security in Global Health. London, UK: Academic Press; 2019. pp. 87-107

[60] Ahuja JKC, Wasswa-Kintu S, Haytowitz DB, Daniel M, Thomas R, Showell B, et al. Sodium content of popular commercially processed and restaurant foods in the United States. Preventive Medicine Reports. 2015;**2**:962-967. DOI: 10.1016/j.

[61] Goldblatt H. Studies on experimental hypertension: III. The production of persistent hypertension in monkeys (macaque) by renal ischemia. The Journal of Experimental Medicine. 1937;**65**: 671-675. DOI: 10.1084/jem.65.5.671

[63] Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. The New England Journal of Medicine. 2001;**344**:3-10. DOI: 10.1056/NEJM200101043440101

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pmedr.2015.11.003

[52] Mueller E, Koehler P, Scherf KA. Applicability of salt reduction strategies

[53] Moreau L, Lagrange J, Bindzus W, Hill S. Influence of sodium chloride on colour, residual volatiles and

acrylamide formation in model systems and breakfast cereals. International Journal of Food Science and

Technology. 2009;**44**:2407-2416. DOI: 10.1111/j.1365-2621.2009.01922.x

[54] Sikora M, Badrie N, Deisingh AK, Kowalski S. Sauces and dressings: A review of properties and applications. Critical Reviews in Food Science and Nutrition. 2008;**48**:50-77. DOI: 10.1080/10408390601079934

Kazaks AG, Geerling JC, Graudal NA. Normal range of human dietary sodium intake: A perspective based on 24-hour urinary sodium excretion worldwide. American Journal of Hypertension. 2013;**26**:1218-1223.

[56] WHO. Salt Reduction-Fact Sheets. 2016. Available from: https://www. who.int/news-room/fact-sheets/detail/

[55] McCarron DA, Stern JS,

DOI: 10.1093/ajh/hpt139

[57] Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: Systematic review and meta-analyses. British Medical Journal. 2013;**346**:f1326. DOI: 10.1136/bmj.

[58] Farquhar WB, Edwards DG, Jurkovitz CT, Weintraub WS. Dietary

salt-reduction

in pizza crust. Food Chemistry. 2016;**192**:1116-1123. DOI: 10.1016/j.

foodchem.2015.07.066

microbiological quality of coldsmoked Salmon during storage at 5°C as estimated by the factorial design method. Journal of Food Protection. 2000;**63**:502-508. DOI: 10.4315/0362-028X-63.4.502

*The Role of Salt on Food and Human Health DOI: http://dx.doi.org/10.5772/intechopen.86905*

*Salt in the Earth*

[35] Lücke FK. Fermented sausages. In: Wood BJB, editor. Microbiology of Fermented Foods. 2nd ed. London, US: Fox PF, Cotter PD, Everett DW, editors. Cheese. 4th ed. San Diego: Academic

[44] Brown A. Fish and shellfish. In: Understanding Food: Principles and Preparation. 6th ed. Boston, MA, USA:

[45] Ruethers T, Taki AC, Johnston EB, Nugraha R, Le TTK, Kalic T, et al. Seafood allergy: A comprehensive review of fish and shellfish allergens. Molecular Immunology. 2018;**100**:28-57. DOI: 10.1016/j.molimm.2018.04.008

[46] Pedro S, Nunes ML. Reducing salt in seafood products. In: Kilcast D, Angus F,

editors. Reducing Salt in Foods: Practical Strategies. Boca Raton: CRC

[47] Mariutti LRB, Bragagnolo N. Influence of salt on lipid oxidation in meat and seafood products: A review. Food Research International. 2017;**94**:90-100. DOI: 10.1016/j.

[48] Albarracín W, Sánchez IC, Grau R, Barat JM. Salt in food processing; usage and reduction: A review. International

Technology. 2011;**46**:1329-1336. DOI: 10.1111/j.1365-2621.2010.02492.x

[49] Andrés A, Rodríguez-Barona S,

manufacturing: Influence of salting procedure on process yield and product

[50] Skåra T, Axelsson L, Stefánsson G, Ekstrand B, Hagen H. Fermented and ripened fish products in the northern European countries. Journal of Ethnic Foods. 2015;**2**:18-24. DOI: 10.1016/j.

[51] Leroi F, Joffraud JJ, Chevalier F. Effect of salt and smoke on the

characteristics. Journal of Food Engineering. 2005;**69**:467-471. DOI: 10.1016/j.jfoodeng.2004.08.040

Press; 2007. pp. 256-282

foodres.2017.02.003

Journal of Food Science and

Barat JM, Fito P. Salted cod

jef.2015.02.004

Press; 2017. pp. 317-375

Cengage; 2019. pp. 165-186

Springer; 1998. pp. 441-483

187. DOI: 10.1111/jtxs.12169

2015. pp. 217-225

2015. pp. 195-205

[37] Flores M, Olivares A. Flavor. In: Toldrá F, editor. Handbook of Fermented Meat and Poultry. 2nd ed. West Sussex, UK: Wiley-Blackwell;

[38] Møller JKS, Jongberg S, Skibsted LH. Color. In: Toldrá F, editor. Handbook of Fermented Meat and Poultry. 2nd ed. West Sussex, UK: Wiley-Blackwell;

[39] Toldrá F. Proteolysis and lipolysis in flavour development of drycured meat products. Meat Science. 1998;**49**(Supplement 1):S101-S110. DOI:

[40] Belz MCE, Ryan LAM, Arendt EK. The impact of salt reduction in bread: A review. Critical Reviews in Food Science and Nutrition. 2012;**52**:514-524. DOI: 10.1080/10408398.2010.502265

[41] Nooshkam M, Varidi M, Bashash M. The Maillard reaction products as foodborn antioxidant and antibrowning agents in model and real food systems. Food Chemistry. 2019;**275**:644-660. DOI: 10.1016/j.foodchem.2018.09.083

[42] Simsek S, Martinez MO. Quality of dough and bread prepared with sea salt or sodium chloride. Journal of Food Process Engineering. 2016;**39**: 44-52. DOI: 10.1111/jfpe.12197

[43] Guinee TP, Fox PF. Chapter 13— Salt in cheese: Physical, chemical and biological aspects. In: McSweeney PLH,

10.1016/S0309-1740(98)90041-9

[36] Çarkcioğlu E, Rosenthal AJ, Candoğan K. Rheological and textural properties of sodium reduced salt soluble myofibrillar protein gels containing sodium tri-polyphosphate. Journal of Texture Studies. 2016;**47**:181-

**38**

microbiological quality of coldsmoked Salmon during storage at 5°C as estimated by the factorial design method. Journal of Food Protection. 2000;**63**:502-508. DOI: 10.4315/0362-028X-63.4.502

[52] Mueller E, Koehler P, Scherf KA. Applicability of salt reduction strategies in pizza crust. Food Chemistry. 2016;**192**:1116-1123. DOI: 10.1016/j. foodchem.2015.07.066

[53] Moreau L, Lagrange J, Bindzus W, Hill S. Influence of sodium chloride on colour, residual volatiles and acrylamide formation in model systems and breakfast cereals. International Journal of Food Science and Technology. 2009;**44**:2407-2416. DOI: 10.1111/j.1365-2621.2009.01922.x

[54] Sikora M, Badrie N, Deisingh AK, Kowalski S. Sauces and dressings: A review of properties and applications. Critical Reviews in Food Science and Nutrition. 2008;**48**:50-77. DOI: 10.1080/10408390601079934

[55] McCarron DA, Stern JS, Kazaks AG, Geerling JC, Graudal NA. Normal range of human dietary sodium intake: A perspective based on 24-hour urinary sodium excretion worldwide. American Journal of Hypertension. 2013;**26**:1218-1223. DOI: 10.1093/ajh/hpt139

[56] WHO. Salt Reduction-Fact Sheets. 2016. Available from: https://www. who.int/news-room/fact-sheets/detail/ salt-reduction

[57] Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: Systematic review and meta-analyses. British Medical Journal. 2013;**346**:f1326. DOI: 10.1136/bmj. f1326

[58] Farquhar WB, Edwards DG, Jurkovitz CT, Weintraub WS. Dietary sodium and health: More than just blood pressure. Journal of the American College of Cardiology. 2015;**65**:1042- 1050. DOI: 10.1016/j.jacc.2014.12.039

[59] Fedacko J, Takahashi T, Singh RB, Pella D, Chibisov S, Hristova K, et al. Chapter 6—Globalization of diets and risk of noncommunicable diseases. In: Singh RB, Watson RR, Takahashi T, editors. The Role of Functional Food Security in Global Health. London, UK: Academic Press; 2019. pp. 87-107

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[85] Stanley RE, Bower CG, Sullivan GA. Influence of sodium chloride reduction and replacement with potassium chloride based salts on the sensory and physico-chemical characteristics of pork sausage patties. Meat Science.

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[109] Quilez J, Salas-Salvado J. Salt in bread in Europe: Potential benefits of reduction. Nutrition Reviews. 2012;**70**:666-678. DOI: 10.1111/j.1753-4887.2012.00540.x

[110] El-Bakry M. Salt in Cheese: A Review. Current Research in Dairy Sciences. 2012;**4**:1-5. DOI: 10.3923/crds.2012.1.5

[111] Bae I, Park J-H, Choi H-Y, Jung H-K. Emerging innovations to reduce the salt content in cheese; effects of salt on flavor, texture, and shelf life of cheese; and current salt usage: A review. Korean Journal for Food Science of Animal Resources. 2017;**37**:793-798. DOI: 10.5851/kosfa.2017.37.6.793

[112] Hendriksen MA, Hoogenveen RT, Hoekstra J, Geleijnse JM, Boshuizen HC, van Raaij JM. Potential effect of salt reduction in processed foods on health. The American Journal of Clinical Nutrition. 2013;**99**:446-453. DOI: 10.3945/ajcn.113.062018

[113] WHO. The Salt Habit: The SHAKE Technical Package for Salt Reduction. Report No.: 978 92 4 151134 6. Geneva, Switzerland: WHO Library; 2016

[114] WHO. Mapping Salt Reduction Initiatives in the WHO European Region; 2013

[115] Survey on Members States' Implementation of the EU Salt Reduction Framework; 2013

[116] Salt Smart Consortium Consensus Statement; 2015

[117] Nilson EAF, Spaniol AM, Gonçalves VSS, Moura I, Silva SA, L'Abbé M, et al. Sodium reduction in processed foods in Brazil: Analysis of food categories and voluntary targets from 2011 to 2017. Nutrients. 2017;**9**:742. DOI: 10.3390/nu9070742

[118] DGS. 2019. Available from: https:// www.dgs.pt/em-destaque/dgs-assinaprotocolos-com-a-industria-alimentarpara-uma-alimentacao-mais-saudavel. aspx

[119] Guenther P, Casavale K, Kirkpatrick S, Reedy J, Hiza H, Kuczynski K, et al. Update of the healthy eating index: HEI-2010. Journal of the Academy of Nutrition and Dietetics. 2013;**113**:569-580. DOI: 10.1016/j.jand.2012.12.016

[120] Kresser C. Shaking Up the Salt Myth. 2019. Available from: https:// chriskresser.com/specialreports/salt/

**45**

**Chapter 3**

**Abstract**

**1. Introduction**

Salt Intake

*Boris Kovač and Urška Blaznik*

Systematic Reduction of Excessive

This chapter emphasizes the health outcomes connected with excessive salt consumption and focuses on possibilities to reduce dietary salt intake. The biggest reductions in salt consumption in the population could be achieved by comprehensive strategies involving population-wide policies (regulation, mandatory reformulation and food labelling). Salt reduction policies include the baseline identification of population's salt consumption and major sources of salt in the diet, reformulation of a set number of products available on the market and increased awareness and knowledge on salt reduction at an individual level, creating an environment for salt reduction and the promotion of 'healthy food'. Innovative reformulation by food industry, therefore, has the potential to contribute substantially. Flavours of processed foods could be improved by partially replacing salt with salt substitutes and flavour enhancers. One of the approaches of salt reduction is 'gradual reduction without the consumer's knowledge', which refers to the observation that people in general are unable to differentiate between two substances in which the difference in salt content is low. It is suggested that increased knowledge and appropriate promotion of healthy food and healthy dietary habits, especially in early childhood in kindergartens, schools and

at home, are the most promising measures for salt reduction.

salt reduction policies, adequate dietary habits, WHO

**Keywords:** excessive salt intake, cardiac diseases, products reformulation,

Salt is the primary source of sodium, and high salt intake is associated with hypertension and increased risk of heart diseases and stroke [1–4]. It is well known that high salt intake is the major cause of raised blood pressure and accordingly leads to cardiovascular diseases. Well-conducted cohort studies and few intervention trials showed that a lower salt consumption is connected with lower risk of cardiovascular events [4–6]. Studies [7–9] also suggest a link between excessive salt intake and gastric cancer and type 1 diabetes. A modest reduction in salt intake has a significant effect on blood pressure both in individuals with raised blood pressure and in those with normal blood pressure. These findings provide additional support for a reduction in population salt intake. Furthermore, the meta-analysis [5] shows a dose-response correlation between the reduction in salt intake and the drop in blood pressure. Sodium reduction results in a decrease in blood pressure in normotensives; decrease in hypertension; a significant increase in plasma renin, plasma aldosterone level, plasma adrenaline and plasma noradrenaline; an increase in LDL cholesterol; and an increase in triglyceride [10]. Systematic study and meta-analysis

#### **Chapter 3**

## Systematic Reduction of Excessive Salt Intake

*Boris Kovač and Urška Blaznik*

#### **Abstract**

This chapter emphasizes the health outcomes connected with excessive salt consumption and focuses on possibilities to reduce dietary salt intake. The biggest reductions in salt consumption in the population could be achieved by comprehensive strategies involving population-wide policies (regulation, mandatory reformulation and food labelling). Salt reduction policies include the baseline identification of population's salt consumption and major sources of salt in the diet, reformulation of a set number of products available on the market and increased awareness and knowledge on salt reduction at an individual level, creating an environment for salt reduction and the promotion of 'healthy food'. Innovative reformulation by food industry, therefore, has the potential to contribute substantially. Flavours of processed foods could be improved by partially replacing salt with salt substitutes and flavour enhancers. One of the approaches of salt reduction is 'gradual reduction without the consumer's knowledge', which refers to the observation that people in general are unable to differentiate between two substances in which the difference in salt content is low. It is suggested that increased knowledge and appropriate promotion of healthy food and healthy dietary habits, especially in early childhood in kindergartens, schools and at home, are the most promising measures for salt reduction.

**Keywords:** excessive salt intake, cardiac diseases, products reformulation, salt reduction policies, adequate dietary habits, WHO

#### **1. Introduction**

Salt is the primary source of sodium, and high salt intake is associated with hypertension and increased risk of heart diseases and stroke [1–4]. It is well known that high salt intake is the major cause of raised blood pressure and accordingly leads to cardiovascular diseases. Well-conducted cohort studies and few intervention trials showed that a lower salt consumption is connected with lower risk of cardiovascular events [4–6]. Studies [7–9] also suggest a link between excessive salt intake and gastric cancer and type 1 diabetes. A modest reduction in salt intake has a significant effect on blood pressure both in individuals with raised blood pressure and in those with normal blood pressure. These findings provide additional support for a reduction in population salt intake. Furthermore, the meta-analysis [5] shows a dose-response correlation between the reduction in salt intake and the drop in blood pressure. Sodium reduction results in a decrease in blood pressure in normotensives; decrease in hypertension; a significant increase in plasma renin, plasma aldosterone level, plasma adrenaline and plasma noradrenaline; an increase in LDL cholesterol; and an increase in triglyceride [10]. Systematic study and meta-analysis

of prospective studies [8, 9] show that dietary salt intake is directly connected with the risk of gastric cancer in prospective population studies—the bigger the consumption of salt, the greater the risk of cancer. An overview study suggested [9] that dietary salt restriction as part of medical nutritional therapy would be useful in patients with type 1 diabetes, while the association between dietary salt intake and health status in patients with type 2 diabetes are confusing. Recently, some studies have shown that high salt intake is correlated with an increased risk for obesity [11, 12]. One of the reasons for this correlation could be the fact that high salt intake stimulates thirst and increases fluid intake and therefore increases the consumption of sugar-containing beverages [13]. The connection between salt intake and obesity may also be partially caused by excessive consumption of processed food that is high in both calories and salt. However, more and more evidence suggest that excessive salt intake is a potential risk factor for obesity regardless of energy intake [11, 13].

It is also recommended to reduce sodium/salt intake in children in order to control blood pressure. These recommendations recognise that salt reduction is compatible with salt iodization, which is considered as a key public health measure for assuring adequate iodine intake in iodine-deficient countries. Sufficient dietary intake of iodine is crucial for preventing iodine-deficiency disorders such as goitre, neurocognitive impairment, hyperthyroidism and hypothyroidism [14, 15]. Iodized salt used for cooking and at the table in households continues to be the major source of iodine in many countries around the world [15]. Dietary salt reduction should be complementary also with the increased level of potassium consumption. Epidemiological studies suggest that for determining the relation between blood pressure and cardiovascular disease risks, the optimal sodium-to-potassium ratio may be more important than individual levels of sodium and potassium [16, 17]. Potassium is commonly found in a variety of unrefined foods, especially fruits and vegetables; food processing reduces the amount of potassium in many food products, and a diet high in processed foods and low in fresh fruits and vegetables is often lacking in potassium. On the other hand, it is important to stress that excessive potassium intake could be reached by consuming some salt replacers. Consumed in excess, potassium may be harmful for some people with kidney problems.

#### **2. Dietary salt reduction policies**

Increasing production of processed food, rapid urbanisation, and changing lifestyles are transforming dietary patterns. Highly processed foods are more and more available and are becoming more affordable. People around the world are consuming more energy-dense foods that are high in saturated fats, sugars, and salt. The evidence supporting global actions for a moderate reduction in salt consumption in order to prevent cardiovascular diseases are strong as recently demonstrated in a scientific statement from the European Salt Action Network (E.S.A.N.) by Cappucio et al. [18].

The overall goal of the global salt reduction push is a 30% relative reduction in average population salt intake towards the World Health Organisation (WHO) recommended level which is less than 5 g per day for adults [19]. This is the only a nutrition-specific target and a core component of the Global Action Plan for the prevention and control of noncommunicable diseases 2013–2020 [20], which aims to achieve a 25% reduction in premature mortality from avoidable noncommunicable diseases (NCDs) by 2025.

The number of countries that are taking action on salt reduction is increasing, but further action is critical to reduce the health consequences of consuming too much salt, particularly in low- and middle-income countries where the risk of

**47**

**Figure 1.**

*Systematic Reduction of Excessive Salt Intake DOI: http://dx.doi.org/10.5772/intechopen.86906*

political commitment [23].

low salt products;

consumption;

out by the SHAKE package [22], are:

healthy products available and affordable;

workplaces, communities and cities; and

*Interventions classified on the upstream/downstream continuum; adapted from [24].*

death from high blood pressure is more than double that in high-income countries [21]. The WHO has been promoting the use of the SHAKE tools to assist Member states technically [22]. Strategies for salt reduction will differ in each setting, but it is likely that the main element of the strategy will be a combination of actions targeting consumers, industry, and government in addition to strong leadership and

Important elements in interventions to reduce salt intake in the population, set

• government policies—including appropriate fiscal policies and regulations to ensure that food manufacturers and retailers produce healthier foods or make

• working with the private sector to improve the availability and accessibility of

• consumer awareness and empowerment of populations through social marketing and mobilisation to raise awareness of the need to reduce salt intake

• creating an enabling environment for salt reduction through local policy interventions and the promotion of 'healthy food' settings such as schools,

• monitoring of population salt intake, sources of salt in the diet and consumer knowledge, attitudes and behaviours relating to salt to inform policy decisions.

Recent systematic review of salt reduction interventions by Hyseni et al. [24] introduced 'effectiveness hierarchy' of interventions (**Figure 1**) that suggested the biggest reductions in salt consumption in the population could be achieved by comprehensive strategies involving 'upstream' population-wide policies (regulation, mandatory reformulation and food labelling). This is particularly emphasized in middle-to-low income countries, as this is the only way to successfully change the food environment and thereby achieve a reduced salt intake in the population [25, 26]. 'Downstream' individually-based interventions appeared relatively weak

#### *Systematic Reduction of Excessive Salt Intake DOI: http://dx.doi.org/10.5772/intechopen.86906*

*Salt in the Earth*

of prospective studies [8, 9] show that dietary salt intake is directly connected with the risk of gastric cancer in prospective population studies—the bigger the consumption of salt, the greater the risk of cancer. An overview study suggested [9] that dietary salt restriction as part of medical nutritional therapy would be useful in patients with type 1 diabetes, while the association between dietary salt intake and health status in patients with type 2 diabetes are confusing. Recently, some studies have shown that high salt intake is correlated with an increased risk for obesity [11, 12]. One of the reasons for this correlation could be the fact that high salt intake stimulates thirst and increases fluid intake and therefore increases the consumption of sugar-containing beverages [13]. The connection between salt intake and obesity may also be partially caused by excessive consumption of processed food that is high in both calories and salt. However, more and more evidence suggest that excessive salt intake is a potential risk factor for obesity regardless of energy intake [11, 13]. It is also recommended to reduce sodium/salt intake in children in order to control blood pressure. These recommendations recognise that salt reduction is compatible with salt iodization, which is considered as a key public health measure for assuring adequate iodine intake in iodine-deficient countries. Sufficient dietary intake of iodine is crucial for preventing iodine-deficiency disorders such as goitre, neurocognitive impairment, hyperthyroidism and hypothyroidism [14, 15]. Iodized salt used for cooking and at the table in households continues to be the major source of iodine in many countries around the world [15]. Dietary salt reduction should be complementary also with the increased level of potassium consumption. Epidemiological studies suggest that for determining the relation between blood pressure and cardiovascular disease risks, the optimal sodium-to-potassium ratio may be more important than individual levels of sodium and potassium [16, 17]. Potassium is commonly found in a variety of unrefined foods, especially fruits and vegetables; food processing reduces the amount of potassium in many food products, and a diet high in processed foods and low in fresh fruits and vegetables is often lacking in potassium. On the other hand, it is important to stress that excessive potassium intake could be reached by consuming some salt replacers. Consumed in

excess, potassium may be harmful for some people with kidney problems.

Increasing production of processed food, rapid urbanisation, and changing lifestyles are transforming dietary patterns. Highly processed foods are more and more available and are becoming more affordable. People around the world are consuming more energy-dense foods that are high in saturated fats, sugars, and salt. The evidence supporting global actions for a moderate reduction in salt consumption in order to prevent cardiovascular diseases are strong as recently demonstrated in a scientific statement from the European Salt Action Network (E.S.A.N.) by

The overall goal of the global salt reduction push is a 30% relative reduction in average population salt intake towards the World Health Organisation (WHO) recommended level which is less than 5 g per day for adults [19]. This is the only a nutrition-specific target and a core component of the Global Action Plan for the prevention and control of noncommunicable diseases 2013–2020 [20], which aims to achieve a 25% reduction in premature mortality from avoidable noncommuni-

The number of countries that are taking action on salt reduction is increasing, but further action is critical to reduce the health consequences of consuming too much salt, particularly in low- and middle-income countries where the risk of

**2. Dietary salt reduction policies**

Cappucio et al. [18].

cable diseases (NCDs) by 2025.

**46**

death from high blood pressure is more than double that in high-income countries [21]. The WHO has been promoting the use of the SHAKE tools to assist Member states technically [22]. Strategies for salt reduction will differ in each setting, but it is likely that the main element of the strategy will be a combination of actions targeting consumers, industry, and government in addition to strong leadership and political commitment [23].

Important elements in interventions to reduce salt intake in the population, set out by the SHAKE package [22], are:


Recent systematic review of salt reduction interventions by Hyseni et al. [24] introduced 'effectiveness hierarchy' of interventions (**Figure 1**) that suggested the biggest reductions in salt consumption in the population could be achieved by comprehensive strategies involving 'upstream' population-wide policies (regulation, mandatory reformulation and food labelling). This is particularly emphasized in middle-to-low income countries, as this is the only way to successfully change the food environment and thereby achieve a reduced salt intake in the population [25, 26]. 'Downstream' individually-based interventions appeared relatively weak

**Figure 1.** *Interventions classified on the upstream/downstream continuum; adapted from [24].* (e.g. dietary counselling for individuals, media campaigns in isolation). Effects of population-wide policies size from 4 g/day in Finland in Japan, 3 g/day in Turkey and 1.3 g/day in the UK. It has been estimated that mandatory reformulation alone could achieve only a reduction of approximately 1.4 g/day.

Different countries are currently at different stages in the development and/or implementation of salt reduction initiatives. In the United Kingdom, the Scientific Advisory Committee on Nutrition published its Salt and Health report already in 2003, which recommended that salt intake should be reduced to no more than 6 g/ day for adults. Government in 2006, challenging the food industry to reduce salt in everyday foods, first introduced salt targets. Salt reduction has been ongoing for more than a decade, and many food categories have shown much improvement, with some products like breakfast cereals now 40% less salty than a decade ago [27]. EU salt reduction activities within E.S.A.N. consider development and alignment of product-specific targets, expanding methods of monitoring food composition, modelling the health impact of efforts and enhancing the knowledge about consumer attitudes, knowledge and behaviours [28]. In the USA, salt reduction work spans across federal, state, and local government agencies. Voluntary efforts by the food industry have been unsuccessful in lowering overall salt intake; further changes in the food supply are needed to bring salt intake within recommended levels [29]. The Australian Federal Government launched Food and Health Dialogue (FHD) in 2010. The focus of the FHD has been on voluntary reformulation of foods, primarily through salt reduction targets [30]. Later in 2015, the Victorian Salt Reduction Partnership (VicSalt Partnership) started bringing together health and research organisations to develop an action plan for salt reduction interventions at a state level [31]. In conclusion, salt reduction activities are currently being implemented through a variety of different programs, but additional efforts and more robust national monitoring mechanisms are required to ensure that countries would achieve the proposed 30% reduction in salt intake within the next decade.

More than 75% of dietary salt comes from the processed foods [32]. Some of the highest contributors of salt to our diets include condiments including table salt, followed by cereals and cereal products (including bread and some types of pizza), meat and meat products (including processed meat such as bacon, ham and sausages) and dairy products (including cheese) [33–35]. Product reformulation by food industry has, therefore, the potential to contribute substantially. However, in order to reduce intakes successfully, consumers need to be encouraged to reduce their salt intake by making healthier food choices and limiting salt used in cooking and added at the table [36–38].

Consumer food selection can be guided by effective and accurate labelling and marketing of food. In salt reduction, the purpose of labelling is to lead food selection towards healthier choices that contain less salt. Nutrition labelling, particularly front-of-pack labelling, may also encourage reformulation of food products. There are a variety of both voluntary and mandatory nutrition labelling systems in use around the world, most commonly applied to pre-packaged food and beverage products. While nutrient declarations (including salt) have to be displayed on all pre-packaged foods, 'front-of-pack' labelling can be used as an additional tool by displaying easily understood information about the nutrient quality of food products (nutrition claims) [39]. Consumers are appealed in salt reduction campaigns to regularly check front-of-pack labels for salt content or scan the barcode using free food scanner apps.

Salt should be seen in the crowded nutrition space, particularly in view of the current consumer concerns around other nutrients, like sugar. Using targeted messaging to highlight the harmful impact of salt on health outcomes was identified as a motivator for behavioural change. For example, the UK government used the message 'Salt Kills' in the first stage of their campaign [37]. In Finland, high-salt

**49**

*Systematic Reduction of Excessive Salt Intake DOI: http://dx.doi.org/10.5772/intechopen.86906*

and limiting the consumption of salty snacks.

diets and increase demand for lower-salt food products [44, 45].

their market success.

needs to be established [47].

warning labels were placed on high salt foods from 1993, resulting in both a

decrease in salt intake and reformulation of foods to reduce salt [40]. With reducing salt in the food products, the maintaining consumer acceptance of the products is a challenge. Consumer's perception of salt-reduced foods is of crucial importance for

Choosing products with lower salt content is one of the possibilities; there are still improvements in eating habits at home. Salt consumption can be reduced by not adding salt during the preparation of food, not having a saltshaker on the table

The knowledge, attitudes and behaviours related to dietary salt intake in highincome countries are low. The same is true for the middle- and low-income countries [41, 42]. Consumers are aware of the health outcomes of a high salt intake, but the fundamental knowledge regarding recommended dietary intake, sources in food and the relationship between salt and sodium is lacking. If in countries with higher income we note that knowledge and more healthy behaviour increase with increasing education, some studies from countries with medium or low income these correlations are not noticed. Their awareness is low regardless of the level of education [42, 43]. Raising awareness of the health impact of salt consumption and the major sources of salt in diets will help to influence consumer behaviour. Strategies that are targeted at behavioural change can then be used to empower people to improve their

Education and communication strategies can lead to changes in social norms relating to salt consumption, increased demand for healthier and lower-salt products, and improvements in overall health for individuals and communities. Economic evaluations clearly show that health education strategies are found to be cost-effective in low- and middle-income countries [46]. Improved health literacy might influence nutritional habits and well-being. However, empirical research on this topic is limited and connection between food and health literacy and diet still

Traditionally, dietary recommendations have been set at the average population level. To affect behaviours relating to salt reduction, mass media campaigns are widely used. Typical campaigns place messages not only in media with large audiences such as television or radio, but also on billboards, posters, magazines and newspapers. However, current research is increasingly showing that the risks, benefits and nutritional requirements strongly vary between different population groups depending on their characteristics. Salt reduction campaigns should therefore use innovative social platforms such as the internet, mobile phones, and personal digital assistants to deliver messages to individual's social network [47]. Salt reduction campaigns, designed as mass media or at the individual level, should be properly planned and preferably be multiyear programmes rather than one-off initiatives. Individuals, who already have elevated blood pressure, and any of the cardiovascular diseases, are advised to decrease salt intake from food [10], so they can follow all salt reduction strategies. A special sub-group of people who have a disease or who are taking medication that can lead to hyponatremia or acute build-up of body water or need a controlled diet may have specific links between sodium intake and health outcomes, and therefore, they require physician-supervised diet [15].

**3. Possibilities of salt reduction in food products by reformulation**

The experiences of the countries that have introduced salt intake reduction measures in the diet of the population show that it is necessary to systematically and gradually reduce the consumption of salt. Salt (NaCl) affects different properties

#### *Systematic Reduction of Excessive Salt Intake DOI: http://dx.doi.org/10.5772/intechopen.86906*

*Salt in the Earth*

(e.g. dietary counselling for individuals, media campaigns in isolation). Effects of population-wide policies size from 4 g/day in Finland in Japan, 3 g/day in Turkey and 1.3 g/day in the UK. It has been estimated that mandatory reformulation alone

Different countries are currently at different stages in the development and/or implementation of salt reduction initiatives. In the United Kingdom, the Scientific Advisory Committee on Nutrition published its Salt and Health report already in 2003, which recommended that salt intake should be reduced to no more than 6 g/ day for adults. Government in 2006, challenging the food industry to reduce salt in everyday foods, first introduced salt targets. Salt reduction has been ongoing for more than a decade, and many food categories have shown much improvement, with some products like breakfast cereals now 40% less salty than a decade ago [27]. EU salt reduction activities within E.S.A.N. consider development and alignment of product-specific targets, expanding methods of monitoring food composition, modelling the health impact of efforts and enhancing the knowledge about consumer attitudes, knowledge and behaviours [28]. In the USA, salt reduction work spans across federal, state, and local government agencies. Voluntary efforts by the food industry have been unsuccessful in lowering overall salt intake; further changes in the food supply are needed to bring salt intake within recommended levels [29]. The Australian Federal Government launched Food and Health Dialogue (FHD) in 2010. The focus of the FHD has been on voluntary reformulation of foods, primarily through salt reduction targets [30]. Later in 2015, the Victorian Salt Reduction Partnership (VicSalt Partnership) started bringing together health and research organisations to develop an action plan for salt reduction interventions at a state level [31]. In conclusion, salt reduction activities are currently being implemented through a variety of different programs, but additional efforts and more robust national monitoring mechanisms are required to ensure that countries would

achieve the proposed 30% reduction in salt intake within the next decade.

More than 75% of dietary salt comes from the processed foods [32]. Some of the highest contributors of salt to our diets include condiments including table salt, followed by cereals and cereal products (including bread and some types of pizza), meat and meat products (including processed meat such as bacon, ham and sausages) and dairy products (including cheese) [33–35]. Product reformulation by food industry has, therefore, the potential to contribute substantially. However, in order to reduce intakes successfully, consumers need to be encouraged to reduce their salt intake by making healthier food choices and limiting salt used in cooking

Consumer food selection can be guided by effective and accurate labelling and marketing of food. In salt reduction, the purpose of labelling is to lead food selection towards healthier choices that contain less salt. Nutrition labelling, particularly front-of-pack labelling, may also encourage reformulation of food products. There are a variety of both voluntary and mandatory nutrition labelling systems in use around the world, most commonly applied to pre-packaged food and beverage products. While nutrient declarations (including salt) have to be displayed on all pre-packaged foods, 'front-of-pack' labelling can be used as an additional tool by displaying easily understood information about the nutrient quality of food products (nutrition claims) [39]. Consumers are appealed in salt reduction campaigns to regularly check front-of-pack labels for salt content or scan the barcode using free food scanner apps. Salt should be seen in the crowded nutrition space, particularly in view of the current consumer concerns around other nutrients, like sugar. Using targeted messaging to highlight the harmful impact of salt on health outcomes was identified as a motivator for behavioural change. For example, the UK government used the message 'Salt Kills' in the first stage of their campaign [37]. In Finland, high-salt

could achieve only a reduction of approximately 1.4 g/day.

**48**

and added at the table [36–38].

warning labels were placed on high salt foods from 1993, resulting in both a decrease in salt intake and reformulation of foods to reduce salt [40]. With reducing salt in the food products, the maintaining consumer acceptance of the products is a challenge. Consumer's perception of salt-reduced foods is of crucial importance for their market success.

Choosing products with lower salt content is one of the possibilities; there are still improvements in eating habits at home. Salt consumption can be reduced by not adding salt during the preparation of food, not having a saltshaker on the table and limiting the consumption of salty snacks.

The knowledge, attitudes and behaviours related to dietary salt intake in highincome countries are low. The same is true for the middle- and low-income countries [41, 42]. Consumers are aware of the health outcomes of a high salt intake, but the fundamental knowledge regarding recommended dietary intake, sources in food and the relationship between salt and sodium is lacking. If in countries with higher income we note that knowledge and more healthy behaviour increase with increasing education, some studies from countries with medium or low income these correlations are not noticed. Their awareness is low regardless of the level of education [42, 43]. Raising awareness of the health impact of salt consumption and the major sources of salt in diets will help to influence consumer behaviour. Strategies that are targeted at behavioural change can then be used to empower people to improve their diets and increase demand for lower-salt food products [44, 45].

Education and communication strategies can lead to changes in social norms relating to salt consumption, increased demand for healthier and lower-salt products, and improvements in overall health for individuals and communities. Economic evaluations clearly show that health education strategies are found to be cost-effective in low- and middle-income countries [46]. Improved health literacy might influence nutritional habits and well-being. However, empirical research on this topic is limited and connection between food and health literacy and diet still needs to be established [47].

Traditionally, dietary recommendations have been set at the average population level. To affect behaviours relating to salt reduction, mass media campaigns are widely used. Typical campaigns place messages not only in media with large audiences such as television or radio, but also on billboards, posters, magazines and newspapers. However, current research is increasingly showing that the risks, benefits and nutritional requirements strongly vary between different population groups depending on their characteristics. Salt reduction campaigns should therefore use innovative social platforms such as the internet, mobile phones, and personal digital assistants to deliver messages to individual's social network [47]. Salt reduction campaigns, designed as mass media or at the individual level, should be properly planned and preferably be multiyear programmes rather than one-off initiatives.

Individuals, who already have elevated blood pressure, and any of the cardiovascular diseases, are advised to decrease salt intake from food [10], so they can follow all salt reduction strategies. A special sub-group of people who have a disease or who are taking medication that can lead to hyponatremia or acute build-up of body water or need a controlled diet may have specific links between sodium intake and health outcomes, and therefore, they require physician-supervised diet [15].

#### **3. Possibilities of salt reduction in food products by reformulation**

The experiences of the countries that have introduced salt intake reduction measures in the diet of the population show that it is necessary to systematically and gradually reduce the consumption of salt. Salt (NaCl) affects different properties

of food: flavour, preservation and texture. All this happens to different extents depending on the type of food product. Reduction of salt in food products is relatively simple if the salt is used only for a sensory aspect. As some salt is needed in foods for functional reasons, engagement with the food industry is an essential first step to understanding the feasibility of reductions in specific foods as well as to encourage reformulation efforts [22]. Lack of salt in a food product can lead for example to unstable meat emulsion products or bread that stales quickly and has frail texture and lighter crust colour. One of the strategies when dealing with texture issues with low salt content is to find solutions that have ionic strength similar as salt. Salt reduction, therefore, means balancing between taste and side effects. When preparing, for example, meat products, salt is not added only to make food tasteful, the salt also extends the shelf life of dried products. NaCl is used as an essential ingredient in processed meat because of its antimicrobial effect, the ability to enrich the flavour of the product and its functional ability to dissolve myofibrillar proteins, which increases the adhesion and cohesiveness of meat particles in processed meat products [48]. The antimicrobial effect of salt is based on its ability to reduce water activity. Inhibition of the growth of microorganisms is in correlation with the amount of salt present in the aqueous phase of food. Adding sodium ions to the meat causes water loss through the semipermeable membrane of bacteria. Water loss is an osmotic shock that can cause bacterial cell death or cause serious injury, resulting in a significant reduction in bacterial activity [48]. Salt can also affect oxygen solubility, reduce enzymatic activity, or consume energy to exclude sodium ions from cells, which can reduce the growth rate of microorganisms [48].

However, taste and microbial stabilisation are not the only reasons for use of high levels of sodium/salt in food. The level of salt is generally kept high due to the additional practical roles it provides. The presence of salt in meat products solubilises meat proteins, activates extraction of proteins, enhances hydration, water holding capacity and formation of heat-stable emulsions. Salt increases cooking yield and juiciness of the product [49, 50]. The consequences of salt reduction could affect shelf life and quality of processed meat products.

Current approaches of salt intake reduction include decreasing of salt content by stealth, using salt alternatives or using flavour enhancers. Reduction by stealth consists of a step-by-step salt reduction over a longer period of time. The major outcome is that modification in saltiness is not detected by consumers. The result should be acceptable saltiness of the product without apparent organoleptic changes determined by consumers [51, 52]. This strategy shows some weaknesses: it is time-consuming and, in addition, to reach everybody, it needs to be applied on a wide scale. All producers should be uncompromisingly involved in the project, otherwise success would not be reached. It is not realistic to expect the industry to do it voluntarily. The producers should be encouraged by a well-prepared regulation that would gradually limit the amount of salt in products [22]. Although a stepby-step approach to a less salty taste in the initial reduction phase would have to work, in general, only a limited amount of salt could be reduced so that the product would not have an unpleasant taste. An atypical taste is a sufficient reason for not purchasing a product. Only when consumers are informed in terms of salt-reduced product, they can actually indicate a preference for a product that has a significantly lower salt level. Results of many studies show that salt perception is very important for consumer acceptability and a reduction in levels is hard to achieve without using salt replacers [53, 54].

A useful strategy to improve the palatability of reduced salt foods relies on the use of common salt replacing ingredients (salt substitutes). Among several options, potassium chloride (KCl) has proved to be an optimal nutritional ingredient for this purpose [55]. It provides similar properties as common salt (NaCl).

**51**

*Systematic Reduction of Excessive Salt Intake DOI: http://dx.doi.org/10.5772/intechopen.86906*

ties and texture of a product.

tutes instead of sodium.

palatability is raising [63].

restaurants or at food preparation at home.

potassium chloride did not result in any side effects.

Calcium and magnesium salts have many side effects; calcium chloride (CaCl2) is salty but with many off-tastes bitter, tastes of MgSO4 are usually perceived only at high levels; CaCl2 can cause irritations on the tongue. Bidlas and Lambert's study results confirmed that in any foods, including cheese, bread, and meat, compared to NaCl, KCl calculated on a molar basis has an equivalent antimicrobial effect [56]. KCl has several unwanted side effects, the most important of which are relatively unnatural taints: bitterness, acridity and metallic taste [55, 56]. Commercially available substitutes are usually mixtures of salts containing sodium chloride, potassium chloride and magnesium sulphate. Not many studies [57, 58] have showed that partial substitution of NaCl by salt mixtures resulted in no negative effects on technological and sensory properties. Study on ground beef patties with the potassium chloride, magnesium sulphate and l-lysine hydrochloride salt mixture [57] did not find significant differences in taste compared to those with sodium chloride. However, the results of Gou et al. [59] are opposite. They evaluated the effect of substitution of sodium chloride with potassium chloride, potassium lactate and glycine on texture, flavour and colour of fermented sausages and dry-cured pork loins. Results confirmed that even partial substitution of sodium chloride with potassium chloride has generally negative effect on sensory proper-

Grummer et al. [60] have analysed the use of mineral salt replacers to reduce the sodium content in cheese; mixtures of NaCl or sea salt with KCl, modified KCl, MgCl2, or CaCl2 were used. Both calcium and magnesium chloride resulted in considerable off-flavours (bitter, metallic, unclean and soapy flavours), while

We can conclude that side effects of alternative recipes are in correlation with nature of the basic material and concentration of salt substitutes. Consumed in excess, potassium may be harmful for some people. Many persons with kidney problems are unable to excrete excessive potassium, which could result in a risky situation what we already pointed in introduction. Persons taking cardiac, kidney or liver medications better check with their personal doctor before using salt substi-

Flavour enhancers are another category of ingredients used to replace the flavouring properties of salt. The most frequently used flavour enhancers are yeast extracts, yeast and vegetable protein hydrolysates, glutamic acid, monosodium glutamate and various nucleotides. Sausages and similar processed meat products are items in which lower-sodium content options have been successful. When flavour enhancers are used, structural functions of salt-soluble proteins need to be partially replaced by the addition of gums, soy or milk proteins and starches [61, 62]. Yeast extracts can be successfully added to any type of food. Functionally, they are used to cover any unwanted bitterness that addition of potassium chloride may have [62]. Hydrolysed vegetable and yeast proteins are flavour enhancers containing high levels of glutamate that also help initiate the umami taste. Partial replacement of salt with monosodium glutamate (<1.0%) did not result in negative sensorial properties of pork patties, although some studies [63] found high deterioration in quality, such as high cooking loss. Some of L-arginyl dipeptides were recently identified as salt flavour enhancers, in consequence, a possibility to reduce dietary salt intake without compromising

Using spice blends and herbs is a promising alternative to improve the quality of reduced salt food products. By giving a spicy flavour and different aroma, these blends can also suppress or diminish negative effects caused by the use of potassium chloride and other replacers. In general, the alternative is easy to apply in industry,

#### *Systematic Reduction of Excessive Salt Intake DOI: http://dx.doi.org/10.5772/intechopen.86906*

*Salt in the Earth*

of food: flavour, preservation and texture. All this happens to different extents depending on the type of food product. Reduction of salt in food products is relatively simple if the salt is used only for a sensory aspect. As some salt is needed in foods for functional reasons, engagement with the food industry is an essential first step to understanding the feasibility of reductions in specific foods as well as to encourage reformulation efforts [22]. Lack of salt in a food product can lead for example to unstable meat emulsion products or bread that stales quickly and has frail texture and lighter crust colour. One of the strategies when dealing with texture issues with low salt content is to find solutions that have ionic strength similar as salt. Salt reduction, therefore, means balancing between taste and side effects. When preparing, for example, meat products, salt is not added only to make food tasteful, the salt also extends the shelf life of dried products. NaCl is used as an essential ingredient in processed meat because of its antimicrobial effect, the ability to enrich the flavour of the product and its functional ability to dissolve myofibrillar proteins, which increases the adhesion and cohesiveness of meat particles in processed meat products [48]. The antimicrobial effect of salt is based on its ability to reduce water activity. Inhibition of the growth of microorganisms is in correlation with the amount of salt present in the aqueous phase of food. Adding sodium ions to the meat causes water loss through the semipermeable membrane of bacteria. Water loss is an osmotic shock that can cause bacterial cell death or cause serious injury, resulting in a significant reduction in bacterial activity [48]. Salt can also affect oxygen solubility, reduce enzymatic activity, or consume energy to exclude sodium

ions from cells, which can reduce the growth rate of microorganisms [48].

affect shelf life and quality of processed meat products.

However, taste and microbial stabilisation are not the only reasons for use of high levels of sodium/salt in food. The level of salt is generally kept high due to the additional practical roles it provides. The presence of salt in meat products solubilises meat proteins, activates extraction of proteins, enhances hydration, water holding capacity and formation of heat-stable emulsions. Salt increases cooking yield and juiciness of the product [49, 50]. The consequences of salt reduction could

Current approaches of salt intake reduction include decreasing of salt content by stealth, using salt alternatives or using flavour enhancers. Reduction by stealth consists of a step-by-step salt reduction over a longer period of time. The major outcome is that modification in saltiness is not detected by consumers. The result should be acceptable saltiness of the product without apparent organoleptic changes determined by consumers [51, 52]. This strategy shows some weaknesses: it is time-consuming and, in addition, to reach everybody, it needs to be applied on a wide scale. All producers should be uncompromisingly involved in the project, otherwise success would not be reached. It is not realistic to expect the industry to do it voluntarily. The producers should be encouraged by a well-prepared regulation that would gradually limit the amount of salt in products [22]. Although a stepby-step approach to a less salty taste in the initial reduction phase would have to work, in general, only a limited amount of salt could be reduced so that the product would not have an unpleasant taste. An atypical taste is a sufficient reason for not purchasing a product. Only when consumers are informed in terms of salt-reduced product, they can actually indicate a preference for a product that has a significantly lower salt level. Results of many studies show that salt perception is very important for consumer acceptability and a reduction in levels is hard to achieve without using

A useful strategy to improve the palatability of reduced salt foods relies on the use of common salt replacing ingredients (salt substitutes). Among several options, potassium chloride (KCl) has proved to be an optimal nutritional ingredient for this purpose [55]. It provides similar properties as common salt (NaCl).

**50**

salt replacers [53, 54].

Calcium and magnesium salts have many side effects; calcium chloride (CaCl2) is salty but with many off-tastes bitter, tastes of MgSO4 are usually perceived only at high levels; CaCl2 can cause irritations on the tongue. Bidlas and Lambert's study results confirmed that in any foods, including cheese, bread, and meat, compared to NaCl, KCl calculated on a molar basis has an equivalent antimicrobial effect [56]. KCl has several unwanted side effects, the most important of which are relatively unnatural taints: bitterness, acridity and metallic taste [55, 56]. Commercially available substitutes are usually mixtures of salts containing sodium chloride, potassium chloride and magnesium sulphate. Not many studies [57, 58] have showed that partial substitution of NaCl by salt mixtures resulted in no negative effects on technological and sensory properties. Study on ground beef patties with the potassium chloride, magnesium sulphate and l-lysine hydrochloride salt mixture [57] did not find significant differences in taste compared to those with sodium chloride. However, the results of Gou et al. [59] are opposite. They evaluated the effect of substitution of sodium chloride with potassium chloride, potassium lactate and glycine on texture, flavour and colour of fermented sausages and dry-cured pork loins. Results confirmed that even partial substitution of sodium chloride with potassium chloride has generally negative effect on sensory properties and texture of a product.

Grummer et al. [60] have analysed the use of mineral salt replacers to reduce the sodium content in cheese; mixtures of NaCl or sea salt with KCl, modified KCl, MgCl2, or CaCl2 were used. Both calcium and magnesium chloride resulted in considerable off-flavours (bitter, metallic, unclean and soapy flavours), while potassium chloride did not result in any side effects.

We can conclude that side effects of alternative recipes are in correlation with nature of the basic material and concentration of salt substitutes. Consumed in excess, potassium may be harmful for some people. Many persons with kidney problems are unable to excrete excessive potassium, which could result in a risky situation what we already pointed in introduction. Persons taking cardiac, kidney or liver medications better check with their personal doctor before using salt substitutes instead of sodium.

Flavour enhancers are another category of ingredients used to replace the flavouring properties of salt. The most frequently used flavour enhancers are yeast extracts, yeast and vegetable protein hydrolysates, glutamic acid, monosodium glutamate and various nucleotides. Sausages and similar processed meat products are items in which lower-sodium content options have been successful. When flavour enhancers are used, structural functions of salt-soluble proteins need to be partially replaced by the addition of gums, soy or milk proteins and starches [61, 62]. Yeast extracts can be successfully added to any type of food. Functionally, they are used to cover any unwanted bitterness that addition of potassium chloride may have [62]. Hydrolysed vegetable and yeast proteins are flavour enhancers containing high levels of glutamate that also help initiate the umami taste. Partial replacement of salt with monosodium glutamate (<1.0%) did not result in negative sensorial properties of pork patties, although some studies [63] found high deterioration in quality, such as high cooking loss. Some of L-arginyl dipeptides were recently identified as salt flavour enhancers, in consequence, a possibility to reduce dietary salt intake without compromising palatability is raising [63].

Using spice blends and herbs is a promising alternative to improve the quality of reduced salt food products. By giving a spicy flavour and different aroma, these blends can also suppress or diminish negative effects caused by the use of potassium chloride and other replacers. In general, the alternative is easy to apply in industry, restaurants or at food preparation at home.

#### **4. Development of adequate dietary habits in early childhood**

Children's eating habits are established in the preschool period. This process is affected by family eating habits as well as preschool nutrition in kindergartens where children usually spend most of the day and consume most of their daily meals. Both, genetic predisposition and learned experience from environment influence children's preferences to salt. The review study [64] states that although the liking of salty food starts as unlearned response in early infancy, this liking soon develops as a result of repeated exposure to salty food. Generally speaking, a low exposure to salty food in infancy is associated with low preference for salty food [64]. No study suggested that decreasing the exposure to salt during infancy is associated with an increased liking of desire for salty foods.

Concern for the quality of food and children eating habits in preschool is, therefore, extremely important for the development and formation of eating habits later in life [64, 65]. Children learn about food through the direct experience of eating and by observing the eating behaviours of others.

Many authors tried to determine whether children find a food product with reduced salt content different enough to assess it as worse than the product with normal salt content [65]. Whether a food is liked or disliked is an important determinant of food intake, especially among children. Salt contributes to the taste of foods and makes them more enjoyable. Salt level has generally a positive impact on the intake of the target foods [66, 67]. Research found that 4-month-old infants identified and selected salted and not plain water, which indicates their salt taste perception mechanism. Six-month-old infants who were fed salty starchy table food retained their tendency towards salty foods later in childhood [68]. Results of the research showed that children aged 4 or more prefer salty foods to unsalted ones. Various studies have shown that after consuming food with reduced salt content for a certain period of time (up to 12 weeks), the preferred level of salt in food is lowered to such a level that foods with high salt content become unpleasant for the subjects [69]. Results of recent research provide evidence that promoting responsive feeding practices can alter the development of eating behaviour, sleep patterns and early self-regulatory skills, as well as reduce the early obesity risk [70]. In a study conducted by Kovač [65], the response of kindergarten children to less salty bread and the role of teachers and teacher assistants in the introduction of novelties into children's nutrition were studied. The purpose of the study was to identify the possibility of unnoticed reduction in salt content of bread as a basic food in the diet of preschool children. The children were not previously told to pay attention to the saltiness of the product. They evaluated the product as a whole. Using emotional faces, the children explained what they thought of the bread they ate. Despite the limitations of the hedonic evaluation, the results gave essential answer—children like bread with reduced salt content. Results demonstrated that 30% reduction in salt was not registered, while a 50% reduction in the salt content, compared to the original recipe, although noted, was not disruptive. These findings partially correspond to the results of Girgis et al. [71] whose results showed that a 25% salt reduction could be made without being noticed. However, the results of the study indicate that children also accept breads with a 50% reduction in the salt content, compared to the original recipe, although the results of some previous studies suggest that children prefer salty foods to unsalted ones [65]. Children did not associate those breads as 'less salty'.

When children go outside their familiar environment, they are influenced by role models. Children look up to different role models in order to help shape their behaviour in school, their relationships, and also making decisions concerning the food. The effectiveness of a child's role model in food preferences depends on the

**53**

*Systematic Reduction of Excessive Salt Intake DOI: http://dx.doi.org/10.5772/intechopen.86906*

specific taste.

**5. Conclusions**

recommended level [20].

**Conflict of interest**

relationship between the child and the role model. For many young children, the most important role models are their parents and caregivers, older people or celebrities. Children also look up to other relatives, teachers and peers. Peers in kindergarten play an important role in shaping children's eating habits [65]. The results of survey [65] and its qualitative answers indicate that educational personnel have a significant impact on children's preference for a specific product or

We can conclude that the environment young children live in, in particular, the persons with whom they are in close contact, is also important when formulating

High salt intake is the major cause of raised blood pressure and accordingly leads to cardiovascular diseases. The overall goal of the global salt reduction push is a 30% relative reduction in average population salt intake towards the WHO-

The availability and accessibility of low-salt products is a very important part of salt reduction measures. Current approaches of reformulation include decreasing of salt by stealth, using salt substitutes, or using flavour enhancers. The most preferred option, especially when preparing food, is the use of fresh or dried spices to flavour the dishes. Consumer awareness of the need to reduce salt intake consumption should be enhanced by effective and accurate labelling and marketing of food. Creation of an enabling environment for salt reduction and promotion of healthy food and healthy dietary habits are the most promising measures especially in early childhood; at home, in kindergartens and schools. Such an approach could represent a basis for creating healthy dietary habits, which will be of particular importance for their whole life. WHO has stated that reducing salt intake has been identified as one of the most cost-effective measures countries can take to improve population health outcomes. Salt reduction measures will generate an extra year of healthy life for a cost that falls below the average annual income or gross domestic product per person. An estimated 2.5 million deaths could be prevented each year if global salt consumption were reduced to the

eating habits and influencing children's acceptance of reduced salt taste.

recommended level that is less than 5 g per day for adults.

The authors declare that no conflict of interests exist.

#### *Systematic Reduction of Excessive Salt Intake DOI: http://dx.doi.org/10.5772/intechopen.86906*

relationship between the child and the role model. For many young children, the most important role models are their parents and caregivers, older people or celebrities. Children also look up to other relatives, teachers and peers. Peers in kindergarten play an important role in shaping children's eating habits [65]. The results of survey [65] and its qualitative answers indicate that educational personnel have a significant impact on children's preference for a specific product or specific taste.

We can conclude that the environment young children live in, in particular, the persons with whom they are in close contact, is also important when formulating eating habits and influencing children's acceptance of reduced salt taste.

#### **5. Conclusions**

*Salt in the Earth*

**4. Development of adequate dietary habits in early childhood**

associated with an increased liking of desire for salty foods.

and by observing the eating behaviours of others.

Children's eating habits are established in the preschool period. This process is affected by family eating habits as well as preschool nutrition in kindergartens where children usually spend most of the day and consume most of their daily meals. Both, genetic predisposition and learned experience from environment influence children's preferences to salt. The review study [64] states that although the liking of salty food starts as unlearned response in early infancy, this liking soon develops as a result of repeated exposure to salty food. Generally speaking, a low exposure to salty food in infancy is associated with low preference for salty food [64]. No study suggested that decreasing the exposure to salt during infancy is

Concern for the quality of food and children eating habits in preschool is, therefore, extremely important for the development and formation of eating habits later in life [64, 65]. Children learn about food through the direct experience of eating

Many authors tried to determine whether children find a food product with reduced salt content different enough to assess it as worse than the product with normal salt content [65]. Whether a food is liked or disliked is an important determinant of food intake, especially among children. Salt contributes to the taste of foods and makes them more enjoyable. Salt level has generally a positive impact on the intake of the target foods [66, 67]. Research found that 4-month-old infants identified and selected salted and not plain water, which indicates their salt taste perception mechanism. Six-month-old infants who were fed salty starchy table food retained their tendency towards salty foods later in childhood [68]. Results of the research showed that children aged 4 or more prefer salty foods to unsalted ones. Various studies have shown that after consuming food with reduced salt content for a certain period of time (up to 12 weeks), the preferred level of salt in food is lowered to such a level that foods with high salt content become unpleasant for the subjects [69]. Results of recent research provide evidence that promoting responsive feeding practices can alter the development of eating behaviour, sleep patterns and early self-regulatory skills, as well as reduce the early obesity risk [70]. In a study conducted by Kovač [65], the response of kindergarten children to less salty bread and the role of teachers and teacher assistants in the introduction of novelties into children's nutrition were studied. The purpose of the study was to identify the possibility of unnoticed reduction in salt content of bread as a basic food in the diet of preschool children. The children were not previously told to pay attention to the saltiness of the product. They evaluated the product as a whole. Using emotional faces, the children explained what they thought of the bread they ate. Despite the limitations of the hedonic evaluation, the results gave essential answer—children like bread with reduced salt content. Results demonstrated that 30% reduction in salt was not registered, while a 50% reduction in the salt content, compared to the original recipe, although noted, was not disruptive. These findings partially correspond to the results of Girgis et al. [71] whose results showed that a 25% salt reduction could be made without being noticed. However, the results of the study indicate that children also accept breads with a 50% reduction in the salt content, compared to the original recipe, although the results of some previous studies suggest that children prefer salty foods to unsalted ones [65]. Children did not associate

When children go outside their familiar environment, they are influenced by role models. Children look up to different role models in order to help shape their behaviour in school, their relationships, and also making decisions concerning the food. The effectiveness of a child's role model in food preferences depends on the

**52**

those breads as 'less salty'.

High salt intake is the major cause of raised blood pressure and accordingly leads to cardiovascular diseases. The overall goal of the global salt reduction push is a 30% relative reduction in average population salt intake towards the WHOrecommended level that is less than 5 g per day for adults.

The availability and accessibility of low-salt products is a very important part of salt reduction measures. Current approaches of reformulation include decreasing of salt by stealth, using salt substitutes, or using flavour enhancers. The most preferred option, especially when preparing food, is the use of fresh or dried spices to flavour the dishes. Consumer awareness of the need to reduce salt intake consumption should be enhanced by effective and accurate labelling and marketing of food. Creation of an enabling environment for salt reduction and promotion of healthy food and healthy dietary habits are the most promising measures especially in early childhood; at home, in kindergartens and schools. Such an approach could represent a basis for creating healthy dietary habits, which will be of particular importance for their whole life. WHO has stated that reducing salt intake has been identified as one of the most cost-effective measures countries can take to improve population health outcomes. Salt reduction measures will generate an extra year of healthy life for a cost that falls below the average annual income or gross domestic product per person. An estimated 2.5 million deaths could be prevented each year if global salt consumption were reduced to the recommended level [20].

#### **Conflict of interest**

The authors declare that no conflict of interests exist.

*Salt in the Earth*

### **Author details**

Boris Kovač1 \* and Urška Blaznik<sup>2</sup>

1 Faculty of Health Sciences, University of Primorska, Izola, Slovenia

2 National Institute of Public Health, Ljubljana, Slovenia

\*Address all correspondence to: boris.kovac@fvz.upr.si

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**55**

*Systematic Reduction of Excessive Salt Intake DOI: http://dx.doi.org/10.5772/intechopen.86906*

[1] Ha SK. Dietary salt intake and hypertension. Electrolyte Blood

[2] World Health Assembly, 66. Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. 2013. Available from: http:// www.who.int/iris/handle/10665/150161

[Accessed: 14 March 2019]

Pressure. 2014;**12**(1):7-18. DOI: 10.5049/

Practice. 2012;**2012**:808120. DOI:

[8] 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;**31**(4):489-498. DOI: 10.1016/j.clnu.2012.01.003 Epub

[9] Horikawa C, Sone H. Dietary salt intake and diabetes complications in patients with diabetes: An overview. Journal of General and Family Medicine. 2017;**18**(1):16-20. DOI: 10.1002/jgf2.10

[10] Graudal NA, Hubeck-Graudal T, Jurgens G. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database of Systematic Reviews. 2017;**4**:CD004022. DOI: 10.1002/14651858.CD004022.pub4

[11] He FJ, Li J, Macgregor GA. High

[12] Oh SW, Koo HS, Han KH, Han SY, Chin HJ. Associations of sodium intake with obesity, metabolic disorder, and albuminuria according to age. PLoS One. 2017;**12**(12):e0188770. Published 2017 Dec 15. DOI: 10.1371/journal.

salt intake independent risk factor for obesity? Hypertension. 2015;**66**:843-849. DOI: 10.1161/ HYPERTENSIONAHA.115.05948

pone.0188770

[13] He FJ, Marrero NM, MacGregor GA. Salt intake is related to soft drink consumption in children and adolescents: A link to obesity? Hypertension. 2008;**51**:629-634. DOI: 10.1161/ HYPERTENSIONAHA.107.100990

[14] Rohner F, Zimmermann M, Jooste P, et al. Biomarkers of nutrition for development-iodine

10.1155/2012/808120

2012 Jan 31

[3] Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: Systematic review and meta-analyses. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews. New York (UK): Centre for Reviews and Dissemination (UK); 2013. Available from: https://www.ncbi.nlm. nih.gov/books/NBK132099/ [Accessed:

[4] Cook NR, Appel LJ, Whelton PK. Lower levels of sodium intake and reduced cardiovascular risk. Circulation. 2014;**129**(9):981-989. DOI: 10.1161/ CIRCULATIONAHA.113.006032

[5] He FJ, MacGregor GA. Salt reduction lowers cardiovascular risk: Metaanalysis of outcome trials. Lancet. 2011;**378**:380-382. DOI: 10.1016/

[6] He FJ, Li J, Macgregor GA. Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised

trials. BMJ. 2013;**346**:f1325. DOI:

[7] Ge S, Feng X, Shen L, Wei Z, Zhu Q, Sun J. Association between habitual dietary salt intake and risk of gastric cancer: A systematic review of observational studies. Gastroenterology Research and

S0140-6736(11)61174-4

10.1136/bmj.f1325

**References**

EBP.2014.12.1.7

14 March 2019]

*Systematic Reduction of Excessive Salt Intake DOI: http://dx.doi.org/10.5772/intechopen.86906*

#### **References**

*Salt in the Earth*

**54**

**Author details**

\* and Urška Blaznik<sup>2</sup>

provided the original work is properly cited.

1 Faculty of Health Sciences, University of Primorska, Izola, Slovenia

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

2 National Institute of Public Health, Ljubljana, Slovenia

\*Address all correspondence to: boris.kovac@fvz.upr.si

Boris Kovač1

[1] Ha SK. Dietary salt intake and hypertension. Electrolyte Blood Pressure. 2014;**12**(1):7-18. DOI: 10.5049/ EBP.2014.12.1.7

[2] World Health Assembly, 66. Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. 2013. Available from: http:// www.who.int/iris/handle/10665/150161 [Accessed: 14 March 2019]

[3] Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: Systematic review and meta-analyses. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews. New York (UK): Centre for Reviews and Dissemination (UK); 2013. Available from: https://www.ncbi.nlm. nih.gov/books/NBK132099/ [Accessed: 14 March 2019]

[4] Cook NR, Appel LJ, Whelton PK. Lower levels of sodium intake and reduced cardiovascular risk. Circulation. 2014;**129**(9):981-989. DOI: 10.1161/ CIRCULATIONAHA.113.006032

[5] He FJ, MacGregor GA. Salt reduction lowers cardiovascular risk: Metaanalysis of outcome trials. Lancet. 2011;**378**:380-382. DOI: 10.1016/ S0140-6736(11)61174-4

[6] He FJ, Li J, Macgregor GA. Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ. 2013;**346**:f1325. DOI: 10.1136/bmj.f1325

[7] Ge S, Feng X, Shen L, Wei Z, Zhu Q, Sun J. Association between habitual dietary salt intake and risk of gastric cancer: A systematic review of observational studies. Gastroenterology Research and

Practice. 2012;**2012**:808120. DOI: 10.1155/2012/808120

[8] 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;**31**(4):489-498. DOI: 10.1016/j.clnu.2012.01.003 Epub 2012 Jan 31

[9] Horikawa C, Sone H. Dietary salt intake and diabetes complications in patients with diabetes: An overview. Journal of General and Family Medicine. 2017;**18**(1):16-20. DOI: 10.1002/jgf2.10

[10] Graudal NA, Hubeck-Graudal T, Jurgens G. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database of Systematic Reviews. 2017;**4**:CD004022. DOI: 10.1002/14651858.CD004022.pub4

[11] He FJ, Li J, Macgregor GA. High salt intake independent risk factor for obesity? Hypertension. 2015;**66**:843-849. DOI: 10.1161/ HYPERTENSIONAHA.115.05948

[12] Oh SW, Koo HS, Han KH, Han SY, Chin HJ. Associations of sodium intake with obesity, metabolic disorder, and albuminuria according to age. PLoS One. 2017;**12**(12):e0188770. Published 2017 Dec 15. DOI: 10.1371/journal. pone.0188770

[13] He FJ, Marrero NM, MacGregor GA. Salt intake is related to soft drink consumption in children and adolescents: A link to obesity? Hypertension. 2008;**51**:629-634. DOI: 10.1161/ HYPERTENSIONAHA.107.100990

[14] Rohner F, Zimmermann M, Jooste P, et al. Biomarkers of nutrition for development-iodine review. The Journal of Nutrition. 2014;**144**(8):1322S-1342S. DOI: 10.3945/ jn.113.181974

[15] Zimmermann MB, Boelaert K. Iodine deficiency and thyroid disorders. The Lancet Diabetes and Endocrinology. 2015;**3**:286-295. DOI: 10.1016/ S2213-8587(14)70225-6

[16] Iwahori T, Miura K, Ueshima H. Time to consider use of the sodium-topotassium ratio for practical sodium reduction and potassium increase. Nutrients. 2017;**9**(7):700. DOI: 10.3390/ nu9070700

[17] Okayama A, Okuda N, Miura K, et al. Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: The NIPPON DATA80 cohort study. BMJ Open. 2016;**6**(7):e011632. DOI: 10.1136/ bmjopen-2016-011632

[18] Cappucio FP, Beer M, Strazzullo P. Population dietary salt reduction and the risk of cardiovascular disease. A scientific statement from the European Salt Action Network. Nutrition, Metabolism and Cardiovascular Diseases. 2019;**29**:107-114. DOI: 10.1016/j.numecd.2018.11.010

[19] World Health Organization. Guideline: Sodium Intake for Adults and Children. Geneva: World Health Organization; 2012. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK133309/ [Accessed: 14 March 2019]

[20] World Health Organization. Global Action Plan for the Prevention and Control of Noncommunicable Diseases. Geneva: World Health Organization; 2013. Available from: https://apps.who.int/iris/bitstream/ handle/10665/94384/9789241506236 eng.pdf;jsessionid=03FBEC2F6C51EB EF87FC5B19B71500AD?sequence=1. [Accessed: 15 March 2019]

[21] World Health Organization. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. Geneva: World Health Organization; 2009. Available from: https://www.who.int/healthinfo/global\_ burden\_disease/GlobalHealthRisks\_ report\_full.pdf [Accessed: 15 March 2019]

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[31] McKenzie B, Trieu K, Grimes CA, et al. Understanding barriers and enablers to state action on salt: Analysis of stakeholder perceptions of the VicHealth salt reduction partnership. Nutrients. 2019;**11**:184. Available from: https://www.mdpi.com/2072- 6643/11/1/184 [Accessed: 15 March 2019]

[32] Feng JH, MacGregor GA. How far should salt intake be reduced. Hypertension. 2003;**42**:1093- 1099. DOI: 10.1161/01. HYP.0000102864.05174.E8

[33] Santos JA, Webster J, Land MA, et al. Dietary salt intake in the

Australian population. Public Health Nutrition. 2017;**20**:1887-1894. DOI: 10.1017/S1368980017000799

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[35] Ribič C, Zakotnik J, Seljak B, et al. Estimation of sodium availability in food in Slovenia: Results from household food purchase data from 2000 to 2009. Slovenian Journal of Public Health. 2014;**53**(2):209-219. DOI: 10.2478/sjph-2014-0021

[36] Dötsch-Klerk M, Goossens WP, Meijer GW, Van het Hof KH. Reducing salt in food; setting product-specific criteria aiming at a salt intake of 5g per day. European Journal of Clinical Nutrition. 2015;**69**(7):799-804. DOI: 10.1038/ejcn.2015.5

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[42] Magalhaes P, Sanhangala EJR, Dombele IM, Ulundo HSN, Capingana DP, Silva ABT. Knowledge, attitude and behaviour regarding dietary salt intake among medical students in Angola. Cardiovascular Journal of Africa. 2015;**26**(2):57-62. DOI: 10.5830/ CVJA-2015-018

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[44] Bhana N, Utter J, Eyles H. Knowledge, attitudes and behaviours related to dietary salt intake in highincome countries: A systematic review. Current Nutrition Reports. 2018;**7**(4): 183-197. DOI: 10.1007/s13668-018-0239-9

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[53] Tobin BD, O'Sullivan MG, Hamill RM, Kerry JP. Effect of varying salt and fat levels on the sensory quality of beef patties. Meat Science. 2012;**91**(4): 460-465. DOI: 10.1016/imeatsci.2012. 02.032

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salt substitutes: A critical review with a focus on the patent. Comprehensive Reviews in Food Science and Food Safety. 2017;**16**(5):881-894. Available from: https://onlinelibrary.wiley.com/ doi/full/10.1111/1541-4337.12291 [Accessed: 15 March 2019]

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[63] Harth L, Krah U, Linke D, Dunkel A,

[64] Liem DG. Infants' and children's salt taste perception and liking: A review. Nutrients. 2017;**9**(9):E1011. DOI:

[65] Kovač B, Knific M. The perception of low-salt bread among preschool children and the role of educational personnel in creating a positive attitude towards reformulated food. Slovenian Journal of Public Health. 2017;**56**(1): 39-46. DOI: 10.1515/sjph-2017-0006

[66] Birch LL. Development of food preferences. Annual Review of

Nutrition. 1999;**19**:41-62. DOI: 10.1146/

[67] Bouhlal S, Issanchou S, Nicklaus S. The impact of salt, fat and sugar levels on toddler food intake. The British Journal of Nutrition. 2011;**105**:645-653. DOI: 10.1017/S0007114510003752

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prospective study. The American Journal of Clinical Nutrition. 2012;**95**:123-129.

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DOI: 10.3945/ajcn.111.014282

Hofmann T, Berger RG. Salt taste enhancing l-arginyl dipeptides from casein and lysozyme released by peptidases of basidiomycota. Journal of Agricultural and Food Chemistry. 2018;**66**(10):2344-2353. DOI: 10.1021/

[Accessed: 15 March 2019]

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[57] Ketenoglu O, Candogan K. Effect of low-sodium salt utilization on some characteristics of ground beef patties. GIDA—Journal of Food. 2011;**36**(2): 63-69. Available from: http://citeseerx. ist.psu.edu/viewdoc/download?doi= 10.1.1.876.9739&rep=rep1&type=pdf

[58] Karagozlu C, Kinik O, Akbulut N. Effects of fully and partial substitution of NaCl by KCl on physico-chemical and sensory properties of white pickled cheese. International Journal of Food Sciences and Nutrition. 2008;**59**(3):181- 191. DOI: 10.1080/09637480701453553

[59] Gou P, Guerrero L, Gelabert J, Arnau J. Potassium chloride, potassium lactate and glycine as sodium chloride substitutes in fermented sausages and in dry-cured pork loin. Meat Science. 1996;**42**(1):37-48. DOI: 10.1016/0309-1740(95)00017-8

[60] Grummer J, Karalus M, Zhang K, Vickers Z, Schoenfuss TC. Manufacture of reduced-sodium Cheddar-style cheese with mineral salt replacers. Journal of Dairy Science. 2012;**95**(6):2830-2839. DOI:

[61] Fellendorf S, O'Sullivan MG, Kerry JP. Impact of ingredient replacers on the physicochemical properties and sensory quality of reduced salt and fat black puddings. Meat Science. 2016;**113**:117-125. DOI: 10.1016/j.meatsci.2015.11.006

10.3168/jds.2011-4851

[Accessed: 15 March 2019]

*Systematic Reduction of Excessive Salt Intake DOI: http://dx.doi.org/10.5772/intechopen.86906*

*Salt in the Earth*

CVJA-2015-018

[41] Trieu K, Ieremia M, Santos J, et al. Effects of a nationwide strategy to reduce salt intake in Samoa. Journal of Hypertension. 2018;**36**(1):188-198. DOI: 10.1097/HJH.0000000000001505

[48] Strategies to Reduce Sodium Intake in the United States. Preservation and physical property roles of sodium in foods. In: Henney JE, Taylor CL, Boon CS, editors. Institute of Medicine (US). Washington (DC): National Academies Press (US); 2010. p. 4. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK50952/ [Accessed: 15 March 2019]

[49] Desmond E. Reducing salt: A challenge for the meat industry. Meat Science. 2006;**74**(1):188-196. DOI: 10.1016/j.meatsci.2006.04.014. 10.1016

[50] Desmond E. Reducing salt in meat and poultry products. In: Kilcast D, Angus F, editors. Reducing Salt in Foods. Cambridge: Woodhead Publishing; 2007. pp. 233-255. DOI: 10.1533/9781845693046.3.233. [Accessed: 15 March 2019]

[51] Kilcast D, Den Ridder C. Sensory issues in reducing salt in food products. In: Kilcast D, Angus F, editors. Reducing Salt in Foods. Cambridge: Woodhead Publishing; 2007. pp. 201-220. DOI: 10.1533/9781845693046.3.233.

[52] Liem DG, Miremadi F, Keast RSJ. Reducing sodium in foods: The effect on flavor. Nutrients. 2011;**3**(6):694-711.

[53] Tobin BD, O'Sullivan MG, Hamill RM, Kerry JP. Effect of varying salt and fat levels on the sensory quality of beef patties. Meat Science. 2012;**91**(4): 460-465. DOI: 10.1016/imeatsci.2012.

[54] Tobin BD, O'Sullivan MG, Hamill RM, Kerry JP. The impact of salt and fat level variation on the physiochemical properties and sensory quality of pork breakfast sausages. Meat Science. 2013;**93**(2):145-152. DOI: 10.1016/j.

[55] Cepanec K, Vugrinec S, Cvetković T, Ranilović J. Potassium chloride based

[Accessed: 15 March 2019]

DOI: 10.3390/nu3060694

meatsci.2012.08.008

02.032

[42] Magalhaes P, Sanhangala EJR, Dombele IM, Ulundo HSN, Capingana DP, Silva ABT. Knowledge, attitude and behaviour regarding dietary salt intake among medical students in Angola. Cardiovascular Journal of Africa. 2015;**26**(2):57-62. DOI: 10.5830/

[43] Alawwa I, Dagash R, Saleh A, Ahmad A. Dietary salt consumption and the knowledge, attitudes and behavior of healthy adults: A cross-sectional study from Jordan. Libyan Journal of Medicine. 2018;**13**(1):1479602. DOI: 10.1080/19932820.2018.1479602

[44] Bhana N, Utter J, Eyles H. Knowledge, attitudes and behaviours related to dietary salt intake in highincome countries: A systematic review. Current Nutrition Reports. 2018;**7**(4): 183-197. DOI: 10.1007/s13668-018-0239-9

10.1093/heapro/daw084

s12962-018-0108-9

[45] Krause C, Sommerhalder K, Beer-Borst S, Abel T. Just a subtle difference? Findings from a systematic review on definitions of nutrition literacy and food literacy. Health Promotion International. 2016;**33**(3):378-389. DOI:

[46] Aminde LN, Takah NF, Zapata-Diomedi B, Veerman JL. Primary and secondary prevention interventions for cardiovascular disease in low-income and middle-income countries: A systematic review of economic evaluations. Cost Effectiveness and Resource Allocation. 2018;**16**:22. DOI: 10.1186/

[47] Wakefield MA, Loken B, Hornik RC.

Use of mass media campaigns to change health behaviour. Lancet. 2010;**376**(9748):1261-1271. DOI: 10.1016/S0140-6736(10)60809-4

**58**

salt substitutes: A critical review with a focus on the patent. Comprehensive Reviews in Food Science and Food Safety. 2017;**16**(5):881-894. Available from: https://onlinelibrary.wiley.com/ doi/full/10.1111/1541-4337.12291 [Accessed: 15 March 2019]

[56] Bidlas E, Lambert RJ. Comparing the antimicrobial effectiveness of NaCl and KCl with a view to salt/sodium replacement. International Journal of Food Microbiology. 2008;**124**(1):98-102. DOI: 10.1016/j.ijfoodmicro.2008.02.031

[57] Ketenoglu O, Candogan K. Effect of low-sodium salt utilization on some characteristics of ground beef patties. GIDA—Journal of Food. 2011;**36**(2): 63-69. Available from: http://citeseerx. ist.psu.edu/viewdoc/download?doi= 10.1.1.876.9739&rep=rep1&type=pdf [Accessed: 15 March 2019]

[58] Karagozlu C, Kinik O, Akbulut N. Effects of fully and partial substitution of NaCl by KCl on physico-chemical and sensory properties of white pickled cheese. International Journal of Food Sciences and Nutrition. 2008;**59**(3):181- 191. DOI: 10.1080/09637480701453553

[59] Gou P, Guerrero L, Gelabert J, Arnau J. Potassium chloride, potassium lactate and glycine as sodium chloride substitutes in fermented sausages and in dry-cured pork loin. Meat Science. 1996;**42**(1):37-48. DOI: 10.1016/0309-1740(95)00017-8

[60] Grummer J, Karalus M, Zhang K, Vickers Z, Schoenfuss TC. Manufacture of reduced-sodium Cheddar-style cheese with mineral salt replacers. Journal of Dairy Science. 2012;**95**(6):2830-2839. DOI: 10.3168/jds.2011-4851

[61] Fellendorf S, O'Sullivan MG, Kerry JP. Impact of ingredient replacers on the physicochemical properties and sensory quality of reduced salt and fat black puddings. Meat Science. 2016;**113**:117-125. DOI: 10.1016/j.meatsci.2015.11.006

[62] Review of Current Salt Replacing Ingredients. Campden BRI Station Road Chipping Campden Gloucestershire. Available from: www.campdenbri.co.uk [Accessed: 15 March 2019]

[63] Harth L, Krah U, Linke D, Dunkel A, Hofmann T, Berger RG. Salt taste enhancing l-arginyl dipeptides from casein and lysozyme released by peptidases of basidiomycota. Journal of Agricultural and Food Chemistry. 2018;**66**(10):2344-2353. DOI: 10.1021/ acs.jafc.6b02716

[64] Liem DG. Infants' and children's salt taste perception and liking: A review. Nutrients. 2017;**9**(9):E1011. DOI: 10.3390/nu9091011

[65] Kovač B, Knific M. The perception of low-salt bread among preschool children and the role of educational personnel in creating a positive attitude towards reformulated food. Slovenian Journal of Public Health. 2017;**56**(1): 39-46. DOI: 10.1515/sjph-2017-0006

[66] Birch LL. Development of food preferences. Annual Review of Nutrition. 1999;**19**:41-62. DOI: 10.1146/ annurev.nutr.19.1.41

[67] Bouhlal S, Issanchou S, Nicklaus S. The impact of salt, fat and sugar levels on toddler food intake. The British Journal of Nutrition. 2011;**105**:645-653. DOI: 10.1017/S0007114510003752

[68] Beauchamp GK, Cowart BJ. Preference for high salt concentrations among children. Developmental Psychology. 1990;**26**:539-545. DOI: 10.1037/0012-1649.26.4.539. [Accessed: 15 March 2019]

[69] Stein LJ, Cowart BJ, Beauchamp GK. The development of salty taste acceptance is related to dietary experience in human infants: A prospective study. The American Journal of Clinical Nutrition. 2012;**95**:123-129. DOI: 10.3945/ajcn.111.014282

[70] Matheson D, Spranger K, Saxe A. Preschool children's perceptions of food and their food experiences. Journal of Nutrition Education. 2002;**34**:85-92. Available from: https://www. sciencedirect.com/science/article/abs/ pii/S1499404606600730 [Accessed: 15 March 2019]

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Section 3

Salt in Technology

61
