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Abstract
BackgroundA “diet high in sodium” is the second most important dietary risk factor for health loss identified in the Global Burden of Disease Study 2013. We therefore aimed to model health gains and costs (savings) of salt reduction interventions related to salt substitution and maximum levels in bread, including by ethnicity and age. We also ranked these four interventions compared to eight other modelled interventions.MethodsA Markov macro-simulation model was used to estimate QALYs gained and net health system costs for four dietary sodium reduction interventions, discounted at 3 % per annum. The setting was New Zealand (NZ) (2.3 million adults, aged 35+ years) which has detailed individual-level administrative cost data.ResultsThe health gain was greatest for an intervention where most (59 %) of the sodium in processed foods was replaced by potassium and magnesium salts. This intervention gained 294,000 QALYs over the remaining lifetime of the cohort (95 % UI: 238,000 to 359,000; 0.13 QALY per 35+ year old). Such salt substitution also produced the highest net cost-savings of NZ$ 1.5 billion (US$ 1.0 billion) (95 % UI: NZ$ 1.1 to 2.0 billion). All interventions generated relatively larger per capita QALYs for men vs women and for the indigenous Māori population vs non-Māori (e.g., 0.16 vs 0.12 QALYs per adult for the 59 % salt substitution intervention). Of relevance to workforce productivity, in the first 10 years post-intervention, 22 % of the QALY gain was among those aged <65 years (and 37 % for those aged <70).ConclusionsThe benefits are consistent with the international literature, with large health gains and cost savings possible from some, but not all, sodium reduction interventions. Health gain appears likely to occur among working-age adults and all interventions contributed to reducing health inequalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3102-1) contains supplementary material, which is available to authorized users.
Highlights
A “diet high in sodium” is the second most important dietary risk factor for health loss identified in the Global Burden of Disease Study 2013
Even when the theoretical minimum level of risk exposure of sodium intake is modelled with very wide uncertainty (from 1000 to 5000 mg of Nghiem et al BMC Public Health (2016) 16:423 dietary sodium per day), the Global Burden of Disease 2013 Study still found that dietary sodium was ranked as the eighth most important risk factor for health loss for developed countries [1]
In terms of modelling background disease trends we took the same approach as the New Zealand Burden of Disease Study (NZBDS) [20], 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
Summary
A “diet high in sodium” is the second most important dietary risk factor for health loss identified in the Global Burden of Disease Study 2013. A diet high in sodium is ranked as the second most important dietary risk factor to health globally according to the Global Burden of Disease Study 2013 [1]. The totality of the evidence appears strong enough to justify public health action (i.e., the evidence from systematic reviews [6, 7] and the data from various key trials [8,9,10]) Such justification is strengthened by more recent evidence that includes: a 2015 review [11]; a systematic review indicating CVD risk reduction benefits of the DASH (low sodium) diet [12]; and a new systematic review on salt and increased CVD mortality [13]. Even when the theoretical minimum level of risk exposure of sodium intake is modelled with very wide uncertainty (from 1000 to 5000 mg of Nghiem et al BMC Public Health (2016) 16:423 dietary sodium per day), the Global Burden of Disease 2013 Study still found that dietary sodium was ranked as the eighth most important risk factor for health loss for developed countries [1]
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