Abstract
BackgroundDietary salt reduction is included in the top five priority actions for non-communicable disease control internationally. We therefore aimed to identify health gain and cost impacts of achieving a national target for sodium reduction, along with component targets in different food groups.MethodsWe used an established dietary sodium intervention model to study 10 interventions to achieve sodium reduction targets. The 2011 New Zealand (NZ) adult population (2.3 million aged 35+ years) was simulated over the remainder of their lifetime in a Markov model with a 3 % discount rate.ResultsAchieving an overall 35 % reduction in dietary salt intake via implementation of mandatory maximum levels of sodium in packaged foods along with reduced sodium from fast foods/restaurant food and discretionary intake (the “full target”), was estimated to gain 235,000 QALYs over the lifetime of the cohort (95 % uncertainty interval [UI]: 176,000 to 298,000). For specific target components the range was from 122,000 QALYs gained (for the packaged foods target) down to the snack foods target (6100 QALYs; and representing a 34–48 % sodium reduction in such products).All ten target interventions studied were cost-saving, with the greatest costs saved for the mandatory “full target” at NZ$1260 million (US$820 million). There were relatively greater health gains per adult for men and for Māori (indigenous population).ConclusionsThis work provides modeling-level evidence that achieving dietary sodium reduction targets (including specific food category targets) could generate large health gains and cost savings for a national health sector. Demographic groups with the highest cardiovascular disease rates stand to gain most, assisting in reducing health inequalities between sex and ethnic groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s12937-016-0161-1) contains supplementary material, which is available to authorized users.
Highlights
Dietary salt reduction is included in the top five priority actions for non-communicable disease control internationally
Even when the theoretical minimum level of risk exposure of sodium intake is modeled with wide uncertainty, it resulted in dietary sodium being ranked as the 11th most important risk factor to health globally in the Global Burden of Disease 2013 Study [1]
In terms of modeling background disease trends we took the same approach as the New Zealand Burden of Disease Study (NZBDS) [22], and assumed a continued decline in incidence rates for both coronary heart disease (CHD) and stroke of 2.0 % annually, and a 2.0 % reduction in casefatality annually i.e., reflecting improved treatment and management
Summary
Dietary salt reduction is included in the top five priority actions for non-communicable disease control internationally. A diet high in sodium is ranked as the second most important dietary risk factor to health globally [1] and salt reduction is included in the top five priority actions for non-communicable disease (NCD) control internationally [2]. The World Health Organization (WHO) has a “strong recommendation” for countries to aim for a 30 % relative reduction in dietary intakes towards 5 g/ day of salt [3]. Even when the theoretical minimum level of risk exposure of sodium intake is modeled with wide uncertainty (from 1000 to 5000 mg of dietary sodium per day), it resulted in dietary sodium being ranked as the 11th most important risk factor to health globally in the Global Burden of Disease 2013 Study [1].
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