Most Singapore residents eat too much salt, prevalence of high blood pressure almost doubled since 2010

SINGAPORE: Nine in 10 people in Singapore are consuming more salt than what is recommended, with the prevalence of hypertension or high blood pressure nearly doubling since 2010, according to surveys by the Ministry of Health (MOH) and Health Promotion Board (HPB).

The findings from MOH's National Population Health Survey 2022 and HPB's National Nutrition Survey 2022 were released on Wednesday (Sep 27). 

MOH’s study tracked the health, risk factors and lifestyle practices of Singapore residents aged 18 to 74, from July 2021 to June 2022. Data was collected from around 8,000 adults through self-reported household interviews and about 9,000 adults through health examinations. 

HPB’s survey monitored the dietary patterns and nutritional status of Singapore residents aged 18 to 69, from December 2021 to August 2022. A total of 3,000 participants were recruited.

The results on Wednesday highlighted a near-doubling in the prevalence of hypertension since 2010. 

High blood pressure - described by MOH as a "long-term rising trend” - went from 19.8 per cent in 2010 to 35.5 per cent in 2019-2020 and 37 per cent in 2021-2022.

“This was observed even after adjusting for the effect of an ageing population,” the Health Ministry added. 

Meanwhile, HPB's survey on nutrition found nine in 10 Singapore residents exceeded the daily recommended intake of less than 2,000mg or one teaspoon of salt.

The daily sodium intake of Singapore residents also increased from 3,480mg in 2019 to 3,620mg in 2022. 

The key drivers behind about 80 per cent of sodium intake were added salt, sauces and seasonings in dishes such as porridge and meat and vegetable soups; gravy and sauce-based dishes such as mee rebus, laksa and curries; stir-fried dishes; fried rice, nasi lemak and chicken rice; as well as the salt added when manufacturing bread and noodles. 

More food items today also contain more than the recommended 2,000mg of sodium per serving, said HPB.

On average, sodium content has increased by 22 per cent per dish from 2010 to 2023, survey results showed. This was due to increases in both portion size and sodium content per 100g of food, HPB added. 

"NOT WINNING THE BATTLE ON LIFESTYLES"

Highlighting the results, Health Minister Ong Ye Kung said on Wednesday: “As of now, we are not winning the battle on lifestyles.”

“Chronic diseases like diabetes, hypertension and high blood cholesterol are consequences of our lifestyles, especially eating habits.  We are what we eat. Food can be medicine if we eat well but it can be poison if we do not,” said Mr Ong during the launch of Project RESET, which looks at Singapore’s population’s metabolism, heart, and liver health as well as lifestyle behaviour.

As the majority of sodium intake comes from eating out, a sodium reduction strategy was launched last year to encourage suppliers for salt and sauces to replace regular salt with lower-sodium alternatives, such as potassium-enriched salt, said Mr Ong.

“The results so far have been quite encouraging. To date, three major suppliers, accounting for close to half of the food and beverage salt market share are now supplying lower-sodium salt,” he said.

More than 350 hawkers, coffeeshop and food court stalls around the country, as well as close to 150 caterers are already using lower-sodium ingredients.

MOH is also considering other measures to reduce sodium content in food through regulatory measures, and has studied how other countries have done so, said Mr Ong.

Citing the example of Chile, he said the South American country has implemented food labelling rules similar to Singapore’s Nutri-Grade label. 

Hence, products exceeding the stipulated sodium threshold must have a "higher in sodium" warning label, said Mr Ong. 

“This is very similar to what we did for sugar but they did it for salt.” 

Finland regulates sodium limits for selected packaged food items that are the main contributors of sodium in their day-to-day diet.

“Both measures have worked. They have spurred industry reformulation and reduced their populations’ sodium intake. We will draw lessons from these examples to consider what would be suitable to implement in our local context,” the Health Minister said.

In the meantime, authorities will embark on a “no regrets move” to call on the industry to reduce the use of sodium in all dishes, he added. 

HPB’s market study has shown that the sodium content of dishes in Singapore has risen by an average of 20 per cent between 2010 and 2023,

As such, HPB will launch a campaign to encourage industry and F&B operators to pledge to reset sodium levels and roll back sodium content in their dishes to the levels in 2010 and “cook like how you used to cook in 2010”.

On MOH and HPB’s bigger push to change Singapore’s dietary habits, Mr Ong said: “I want to assure everyone that we will do so without making our food bland and uninteresting and without depriving people of their favourite past time of eating or undermining the diversity and colour of the Singapore food scene.”

On Wednesday, MOH and HPB also encouraged Singapore residents to use the Healthier Choice symbol to identify ingredients and food products with at least 25 per cent sodium reduction.

“When cooking, herbs, spices and umami ingredients can be used to add flavour to food, without too much salt or seasonings,” they said. 

“When eating out, diners are advised to look out for stores with the Healthier Choice identifier, and ask for less gravy, sauces or soup, as these tend to be high in sodium.”

OBESITY CONTINUES TO RISE

The findings released on Wednesday also found that the prevalence of obesity was 11.6 per cent in 2021-2022, up from 10.5 per cent in 2019-2020 and 8.6 per cent in 2013.

This increase was mainly observed among residents aged 18 to 29 and 40 to 59.

The proportion of residents engaging in sufficient physical activity - defined as at least 150 minutes of moderate intensity in a week - also dropped from 84.6 per cent in 2019 to 74.9 per cent in 2022. This was observed across most age groups, said MOH. 

The ministry said this was likely due to reduced commuting as a result of hybrid work arrangements, which have yet to return to pre-COVID-19 levels.

Just like in 2019, commuting was the largest contributor to total physical activity, at 44 per cent.

This was followed by leisure-time activity such as sports and exercise at 32 per cent, and work-related activity such as household chores at 24.1 per cent.

CALORIES UP, SUGAR DOWN

HPB’s National Nutrition Survey further found that Singapore residents are eating more, with their mean calorie intake increasing from 2,360kcal in 2019 to 2,410kcal in 2022.

About 61 per cent of residents exceeded the recommended intake, which is estimated based on an individual's age, gender, weight and level of physical activity. This was up from 55 per cent in 2019. 

Energy-dense food items and beverages such as fried food, convenience food and desserts made up 60 per cent of total calories consumed, results showed. 

Overall diet composition was also lower in carbohydrates and higher in fat, with total dietary fat intake increasing from 94g in 2019 to 100g in 2022. Of this, 36 per cent consisted of saturated fat, exceeding the recommendation of no more than 30 per cent. 

On the other hand, total sugar intake dropped from 60g in 2018 - prior to the announcement of the Nutri-Grade labelling and advertisement prohibition measures - to 56g in 2022. 

About 67 per cent of residents in 2022 were within the recommended maximum sugar allowance of no more than 10 per cent of daily total energy intake or 10 teaspoons of sugar, compared with 61 per cent in 2019. 

This improvement was driven by changes in the pre-packaged drink industry, said HPB, pointing to new lower-sugar options in the market, higher-sugar ones being reformulated to lower-sugar alternatives, and higher-sugar drinks exiting the market.

The survey also showed that sugar-sweetened beverages remain the single biggest source of dietary sugar, contributing 52 per cent of intake.

Intake of sugar from freshly prepared drinks remained the same. Nutri-Grade labelling and advertisement prohibition measures will be extended to freshly prepared beverages by the end of this year.

During his speech on Wednesday, Health Minister Mr Ong said that the introduction of Nutri-Grade labels has been “very effective”, and that companies have been reformulating their products by reducing the sugar content since the announcement of the measures in 2020.

On the labels being extended to freshly prepared beverages, he said the “new measures will likely have a strong salutary effect”. 

“It will raise awareness of the harm of excessive sugar consumption, and just as manufacturers of pre-packaged beverages reformulated their drinks in anticipation of the change in policy, we hope many drinks outlets that prepare fresh beverages will reduce the sweetness of their drinks when the requirement comes into force at the end of this year.

“If that happens, this presents us with a rare opportunity to reset the norm across the industry,” he said. This means making “siew dai” or less sweet in Hokkien, the new norm and default, Mr Ong added.