S’poreans eating too much salt, more than one in three now has high blood pressure

Nine in 10 Singaporeans are consuming too much salt, and the rate of hypertension has almost doubled since 2010, latest data show.

More than a third of people now suffer from high blood pressure, raising the danger of heart disease and stroke.
Adding to their health risks, people are eating more and moving less.

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

“Chronic diseases like diabetes, hypertension and high blood cholesterol are consequences of our lifestyles, especially eating habits,” said Mr Ong.

“We are what we eat. Food can be medicine if we eat well, but it can be poison if we do not,” he said at the launch of Project Reset, a major cardiovascular research project.

It is a five-year government-funded research initiative seeking to gain a deeper understanding of the population’s metabolism, heart and liver health, as well as lifestyle behaviour, to prevent heart diseases including heart attack and stroke.

According to the latest national health and nutrition report cards for Singapore released on Wednesday, salt intake rose from 3,480mg in 2019 to 3,620mg in 2022, far beyond the recommended daily allowance of 2,000mg.
Over three in five people (61 per cent) have surpassed their calorie intake in 2022, compared to more than one in two (55 per cent) in 2019. When it comes to getting physical, only about seven in 10 (74.9 per cent) in 2022 were up and active, compared with more than eight in 10 (84.6 per cent) in 2019.

But there is some good news: The war on sugar seems to be having an impact, with diabetes and high cholesterol figures down a shade.

Nonetheless, an average of six people are diagnosed with kidney failure each day and require dialysis – diabetes is a major cause of this.

More can be done to manage excessive consumption of sugar and salt – the two most common nutrients that cause the most health problems, stressed Mr Ong.

The Ministry of Health (MOH), through the Health Promotion Board (HPB), will be making a bigger push to shift dietary habits.

This includes making “siew dai” – less sugar in local parlance – in drinks the default option at coffeeshops and other outlets so people have to ask for full sugar, rather than the reverse.

HPB is also working with industry partners to lower sugar levels and declare war on sodium. Its Nutri-Grade, a mandatory nutrition label with four colour-coded grades, will cover freshly prepared drinks by the end of 2023.

When it comes to salt, the board is ramping up its schemes to support research and development, marketing and trade promotions to increase the supply of affordable healthier alternatives, and getting manufacturers and food retailers to reduce sodium in foods.

MOH is also considering regulations to reduce sodium content in food, including labelling similar to the Nutri-Grade label for sugar. Mr Ong said products that exceed the stipulated sodium threshold in Chile have a “high in sodium” warning label. In Finland, sodium limits are regulated for selected packaged food items that are the main contributors of sodium in its population’s daily diet. Both measures have worked and Mr Ong said Singapore will draw lessons from them to consider what would be suitable to implement in the local context.

“We will do so without making our food bland and uninteresting, and without depriving people of their favourite pastime of eating or undermining the diversity and colour of the Singapore food scene,” he said.

“In fact, if done well and appropriately, our efforts can achieve the opposite, which is to enhance our enjoyment of our food in Singapore, and at the same time, make (our) diet healthier.”

The 2022 National Population Health Survey (NPHS) tracked the health and risk factors of residents aged 18 to 74 between July 2021 and June 2022. The National Nutrition Survey (NNS), under HPB, looks at the diet and eating habits of adult Singapore residents, and its latest survey provides information on those aged 18 to 69 years between 2019 and 2022.

The findings highlighted the need for Singaporeans to pay attention to their own health and adopt healthy lifestyle habits. They include a healthy diet, physical activities, stress management and quitting smoking.

According to NPHS, the rate of hypertension or high blood pressure continued its long-term rising trend – moving from 19.8 per cent in 2010 to 35.5 per cent between 2019 and 2020 and to 37 per cent in the latest findings.

The increase was mainly observed in those aged between 50 and 74 years. Among all adults with hypertension, more than half (53.5 per cent) were previously undiagnosed, while two-thirds (64.8 per cent) of known cases had poor control of their condition.

Hypertension happens when the pressure of the blood against the walls of the vessels is consistently high. Left unchecked, it can cause serious damage to the heart or kidneys. It can also burst or block arteries that supply blood and oxygen to the brain, causing a stroke.

Professor Tan Huay Cheem, senior consultant at the National University Heart Centre, Singapore, told The Straits Times that the increase in hypertension rates is probably caused by the high salt intake in tandem with a fast-ageing population.

“From a population public health perspective, a whole population’s salt reduction, even by a small amount, can lower its blood pressure and save millions of people dying unnecessarily from stroke and heart disease,” he said.

Salt alternatives: How to use other ingredients to replace or reduce the use of salt in cooking

The findings were not all doom and gloom.

There was an uptake in pneumococcal vaccination among seniors, where the rate more than doubled from about one in 10 (10.3 per cent) in 2019, prior to the Covid-19 epidemic, to more than one in four (26.5 per cent) in 2022. The vaccine helps to prevent pneumococcal disease, including pneumonia and meningitis, among others.

There was also a dip in diabetes and high cholesterol rates.

The rate of diabetes went down from 9.5 per cent between 2019 and 2020 to 8.5 per cent in the last survey (2021-2022).

And despite more eating fat – with total intake going up from 94g in 2019 to 100g in 2022 – the rate of high cholesterol dropped from 39.1 per cent in 2019 to 31.9 per cent in 2022.

President of the Singapore Nutrition and Dietetics Association Kalpana Bhaskaran said it is reasonable to assume that the decrease in hyperlipidemia, or high cholesterol, is partially attributed to reduced sugar-sweetened beverage consumption and the introduction of the Nutri-Grade label.

“Research has consistently demonstrated a link between high sugar diets and adverse lipid profiles, such as elevated triglycerides (TG), an increased TG/HDL-C ratio, and higher LDL cholesterol, commonly known as ‘bad cholesterol’ levels, all of which are associated with hyperlipidemia,” she explained.

Such figures show that it is possible to make a dent in conditions than can lead to serious diseases and for Singaporeans to take back their health.

Said Mr Ong: “With more proactive and better government action and support, improved clinical care, efforts of researchers, and exercising of personal responsibility, we can work towards a future where chronic diseases such as heart disease are no longer a leading cause of morbidity and mortality.”