Abstract
High sodium intake is estimated to cause approximately 3 million deaths per year worldwide. The estimated average sodium intake of 3.95 g/day far exceeds the recommended intake. Population sodium reduction should be a global priority, while simultaneously ensuring universal salt iodization. This article identifies high priority strategies that address major sources of sodium: added to packaged food, added to food consumed outside the home, and added in the home. To be included, strategies needed to be scalable and sustainable, have large benefit, and applicable to one of four measures of effectiveness: (1) Rigorously evaluated with demonstrated success in reducing sodium; (2) suggestive evidence from lower quality evaluations or modeling; (3) rigorous evaluations of similar interventions not specifically for sodium reduction; or (4) an innovative approach for sources of sodium that are not sufficiently addressed by an existing strategy. We identified seven priority interventions. Four target packaged food: front-of-pack labeling, packaged food reformulation targets, regulating food marketing to children, and taxes on high sodium foods. One targets food consumed outside the home: food procurement policies for public institutions. Two target sodium added at home: mass media campaigns and population uptake of low-sodium salt. In conclusion, governments have many tools to save lives by reducing population sodium intake.
Highlights
Excess consumption of dietary sodium increases blood pressure and the risk of cardiovascular disease (CVD) [1,2,3]
Significant decreases in population blood pressure and in hypertension prevalence between 2010 and 2014 in adults above 30 years
We propose a framework for prioritizing interventions that have the highest potential to reduce population sodium intake, evaluate existing interventions against the proposed framework, and identify and describe the recommended high-impact interventions
Summary
Excess consumption of dietary sodium increases blood pressure and the risk of cardiovascular disease (CVD) [1,2,3]. In 2017, high sodium intake led to approximately 3 million deaths and loss of 70 million disability-adjusted life-years [4]. These devastating outcomes affect a wide range of populations, with four out of five of these deaths occurring in low- and middle-income countries (LMICs), and nearly half among people younger than 70 [5]. Dietary interventions, including limiting sodium consumption from all sources, are an important approach to addressing key risk factors for non-communicable diseases [6]. In 181 of 187 countries, estimated average levels of sodium intake exceed recommendations, with the global average sodium consumption estimated to be approximately 3.95 g per day [5]
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