Abstract
BackgroundExcessive sodium consumption is one of the leading dietary risk factors for non-communicable diseases, including cardiovascular disease (CVD), mediated by high blood pressure. Brazil has implemented voluntary sodium reduction targets with food industries since 2011. This study aimed to analyse the potential health and economic impact of these sodium reduction targets in Brazil from 2013 to 2032.MethodsWe developed a microsimulation of a close-to-reality synthetic population (IMPACTNCD-BR) to evaluate the potential health benefits of setting voluntary upper limits for sodium content as part of the Brazilian government strategy. The model estimates CVD deaths and cases prevented or postponed, and disease treatment costs. Model inputs were informed by the 2013 National Health Survey, the 2008–2009 Household Budget Survey, and high-quality meta-analyses, assuming that all individuals were exposed to the policy proportionally to their sodium intake from processed food. Costs included costs of the National Health System on CVD treatment and informal care costs. The primary outcome measures of the model are cardiovascular disease cases and deaths prevented or postponed over 20 years (2013–2032), stratified by age and sex.ResultsThe study found that the application of the Brazilian voluntary sodium targets for packaged foods between 2013 and 2032 could prevent or postpone approximately 110,000 CVD cases (95% uncertainty intervals (UI): 28,000 to 260,000) among men and 70,000 cases among women (95% UI: 16,000 to 170,000), and also prevent or postpone approximately 2600 CVD deaths (95% UI: − 1000 to 11,000), 55% in men. The policy could also produce a net cost saving of approximately US$ 220 million (95% UI: US$ 54 to 520 million) in medical costs to the Brazilian National Health System for the treatment of CHD and stroke and save approximately US$ 71 million (95% UI: US$ 17 to170 million) in informal costs.ConclusionBrazilian voluntary sodium targets could generate substantial health and economic impacts. The reduction in sodium intake that was likely achieved from the voluntary targets indicates that sodium reduction in Brazil must go further and faster to achieve the national and World Health Organization goals for sodium intake.
Highlights
Excessive sodium consumption is one of the leading dietary risk factors for non-communicable diseases, including cardiovascular disease (CVD), mediated by high blood pressure
These include health education campaigns targeted to the table salt added to foods and meals [10], and since 2011, food reformulation strategies aimed at reducing the sodium content of processed and ultraprocessed products, including condiments, through voluntary upper limits for sodium content in priority food categories [11]
Costs of coronary heart disease (CHD) and stroke From the public healthcare perspective, the voluntary targets for sodium could result in a net saving of approximately US$ 290 million (95% Uncertainty interval (UI): US$ 71 to 690 million) in cumulative hospitalisation, primary health, outpatient, pharmaceutical, and informal care costs, over the 20 years
Summary
Excessive sodium consumption is one of the leading dietary risk factors for non-communicable diseases, including cardiovascular disease (CVD), mediated by high blood pressure. High sodium intake was the leading cause of morbidity and mortality worldwide, accounting for some 3 million deaths and 70 million disability-adjusted life-years (DALYs) [1]. Sodium reduction policies in Brazil have incorporated a set of strategies These include health education campaigns targeted to the table salt added to foods and meals [10], and since 2011, food reformulation strategies aimed at reducing the sodium content of processed and ultraprocessed products, including condiments, through voluntary upper limits for sodium content in priority food categories [11]. From 2011 to 2017, all food categories have reduced their upper limits of sodium and most have reduced their average sodium content, from 8 to 34% [12]
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