A decade of challenges and progression in sodium intake reduction in South Korea

Abstract Background High sodium intake raises blood pressure, increasing cardiovascular risk. The World Health Organization (WHO) and many countries have implemented sodium reduction initiatives. South Korea launched initiatives that initially focused on children and later expanded to include adults. Purpose This study aims to evaluate the effects of South Korea’s decade-long sodium intake reduction efforts and share strategies with other countries facing similar health challenges. Methods The Special Act on Safety Management of Children’s Dietary Lifestyle in 2009 established measures to protect children, regulating sales around schools and advertisements of unhealthy foods. In 2012, the National Plans to Reduce Sodium Intake, amended in 2016, set a 3,500 mg/day target by 2020. Key initiatives included (1) promoting dietary safety for children, (2) awareness campaigns, (3) education on sodium intake reduction, (4) providing low-sodium meals, particularly in childcare centers and schools, (5) reducing sodium content in processed and restaurant foods, and (6) strengthening mandatory nutrition labeling. Sodium intake trends were analyzed using the Korea National Health and Nutrition Examination Survey data. Results The sodium intake of the Korean population decreased by 32.9% from 4831 mg/day in 2010 to 3243 mg/day in 2019. Sodium intake steadily decreased until 2016, but no further significant decline has been observed since 2017. Sodium intake decreased regardless of gender, age group, or income level. Among children and adolescents (≤18 years), intake decreased by 27.2%, from 3481 to 2535 mg/day, while adults (≥19 years) showed a 34.9% reduction from 5194 to 3380 mg/day. The pronounced reductions were among people in their 30s and 50s compared to other age groups, decreasing 36.3% and 37.5%, respectively. The decline remained significant when analyzed as sodium intake per 1000 kcal of energy intake, indicating that the decrease in sodium intake was not due to a reduced energy intake. Furthermore, the proportion of adults with sodium intake less than 2000 mg/day more than doubled from 11% in 2010 to 25.0% in 2019. Similarly, the proportion of children and adolescents with sodium intakes lower than corresponding goals, which were adjusted based on the energy requirement as recommended in the WHO guidelines, more than doubled. Conclusion South Korea has achieved unprecedented success in reducing sodium intake through a comprehensive approach, initially focused on children and expanded to the entire population. Nevertheless, the average sodium intake remains significantly high, exceeding the WHO-recommended 2,000 mg/day by more than 1.5 times. Given the recent plateau in sodium intake trends, policy adjustments appear necessary to sustain progress and achieve further reductions. This study provides valuable insights for other countries implementing sodium reduction strategies.