Abstract
ObjectiveGiven the importance of high sodium diets as a risk factor for disease burden (ranked 11th in importance in the Global Burden of Disease Study 2010), we aimed to determine the feasibility of low-sodium diets that were also low-cost, nutritious and (for some scenarios) included familiar meals.MethodsThe mathematical technique of “linear programming” was used to model eight optimized daily diets (some with uncertainty), including some diets that contained “familiar meals” for New Zealanders or were Mediterranean-, Asian- and Pacific-style diets. Data inputs included nutrients in foods, food prices and food wastage.FindingsUsing nutrient recommendations for men and a cost constraint of <NZ$9/d (US$6.84), the sodium intake levels in the eight optimized daily diets were all well below the 2300 mg/d (5.8 g salt/d) recommended maximum. The only diet to not consistently fall below the recommended “target” upper limit of 1600 mg/d included an evening meal with sausages (median = 1640 mg/d, 95% simulation interval: 1551–1735 mg/d). Many additional nutritional aspects of these optimized low-sodium diets suggest that they would reduce cardiovascular disease risk in other ways (e.g., improved polyunsaturated to saturated fat ratio) and also reduce risk of cancer and other chronic diseases (e.g., via higher intakes of vegetables, fruits and dietary fiber). Even healthier diets (e.g., with higher intakes of fruit) occurred when the cost constraint was relaxed to $NZ15/d (US$11.40). Similar results were obtained when the modeling considered diets for women.ConclusionsThese results provide some reassurance for the feasibility of substantially reducing population sodium intake given currently available low-cost foods and while maintaining some level of familiar meals. Policy makers could consider ways to promote such optimized diets and foods, including regulations on maximum salt levels in processed foods, and taxes on alternative foods that are high in salt, sugar and saturated fat.
Highlights
A high intake of salt in the diet is associated with a significantly increased risk of stroke and total cardiovascular disease according to a meta-analysis of 13 observational studies [1]
These results provide some reassurance for the feasibility of substantially reducing population sodium intake given currently available low-cost foods and while maintaining some level of familiar meals
In the most recent review we identified was by the World Health Organization (WHO), and the findings were that: ‘‘Higher sodium intake was associated with higher risk of incident stroke, fatal stroke and fatal coronary heart disease
Summary
A high intake of salt in the diet is associated with a significantly increased risk of stroke and total cardiovascular disease according to a meta-analysis of 13 observational studies [1]. There is evidence from a Cochrane systematic review that reductions in sodium intake reduce systolic blood pressure (BP) in people defined as ‘‘normotensive’’ by about 1.3 to 4 mm Hg and even more so in people with hypertension (6 to 10 mm Hg reduction) [2]. There is a direct relationship between BP and heart disease, stroke and end-stage renal disease according to a meta-analysis of 61 studies [3]. A recent Cochrane systematic review reported that salt reduction had relatively small benefits on cardiovascular events or mortality, and that uncertainty remained [4]. Its low power has been noted; the analysis only had 10% power to detect a 10% reduction in relative risk [6]
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