Assessment of salt concentration in bread commonly consumed in the Eastern Mediterranean Region

Background: Hypertension is the most important cardiovascular risk factor in the World Health Organization (WHO) Eastern Mediterranean Region. Excessive salt and sodium intake is directly related to hypertension, and its reduction is a priority of WHO. Bread is the leading staple food in the Region; therefore, reducing the amount of salt added to bread could be an effective measure for reducing salt intake. Aim: The study sought to determine the levels of sodium and salt in locally produced staple bread from 8 countries in the Region. Methods: Bread samples were collected randomly from bakeries located in the capital cities of the selected countries. The samples were analysed for sodium content using atomic absorption spectroscopy. Results: The mean salt content of breads varied from 4.28 g/kg in Jordan to 12.41 g/kg in Tunisia. The mean salt and sodium content in bread for all countries was 7.63 (SD 3.12) and 3.0 (SD 1.23) g/kg, respectively. The contribution of bread to daily salt intake varied considerably between countries, ranging from 1.3 g (12.5%) in Jordan to 3.7 g (33.5%) in Tunisia. Conclusion: Interventions to reduce population salt intake should target reduction of salt in bread in all countries. The amount of salt added to bread should be standardized and relevant legislation developed to guide bakers. Setting an upper limit for salt content in flat bread (pita or Arabic bread) at 0.5% is strongly recommended. However, salt levels at <= 1% would be appropriate for other kind of breads.