Salt Reduction Policies Research Articles

Cost-effectiveness analysis of salt reduction policies to reduce coronary heart disease in Syria, 2010-2020.

This study presents a cost-effectiveness analysis of salt reduction policies to lower coronary heart disease in Syria. Costs and benefits of a health promotion campaign about salt reduction (HP); labeling of salt content on packaged foods (L); reformulation of salt content within packaged foods (R); and combinations of the three were estimated over a 10-year time frame. Policies were deemed cost-effective if their cost-effectiveness ratios were below the region's established threshold of $38,997 purchasing power parity (PPP). Sensitivity analysis was conducted to account for the uncertainty in the reduction of salt intake. HP, L, and R+HP+L were cost-saving using the best estimates. The remaining policies were cost-effective (CERs: R=$5,453 PPP/LYG; R+HP=$2,201 PPP/LYG; R+L=$2,125 PPP/LYG). R+HP+L provided the largest benefit with net savings using the best and maximum estimates, while R+L was cost-effective with the lowest marginal cost using the minimum estimates. This study demonstrated that all policies were cost-saving or cost effective, with the combination of reformulation plus labeling and a comprehensive policy involving all three approaches being the most promising salt reduction strategies to reduce CHD mortality in Syria.

How much salt do adults consume in climate vulnerable coastal Bangladesh?

BackgroundEvidence from numerous studies suggests that salt intake is an important determinant of elevated blood pressure. Robust data about salt consumption among adults in Bangladesh is sparse. However, much evidence suggests saline intrusion due to sea level rise as a result of climate change exposes more than 20 million people to adverse effects of salinity through the food and water supply. The objective of our study was to assess salt consumption among adults in a coastal region of Bangladesh.MethodsOur study was cross sectional and conducted during October-November 2011. A single 24 hour urine was collected from 400 randomly selected individuals over 18 years of age from Chakaria, a rural, coastal area in Southeastern Bangladesh. Logistic regression was conducted to identify the determinants of high salt consumption.ResultsThe mean urinary sodium excretion was 115 mmol/d (6.8 g salt). Based on logistic regression using two different cutoff points (IOM and WHO), housewives and those living in the coastal area had a significantly higher probability of high salt intake compared with people who were engaged in labour-intensive occupations and who lived in hilly areas.ConclusionIt is important to create awareness about the implication of excessive salt intake on health and to develop strategies for reducing salt intake that can be implemented at the community-level. A sustainable policy for salt reduction in the Bangladeshi diet should be formulated with special emphasis on coastal areas.

PT322 Potential disability-adjusted life years gained from a comprehensive salt reduction policy in South Africa

PT322 Potential disability-adjusted life years gained from a comprehensive salt reduction policy in South Africa

Call for salt-reduction policies

Call for salt-reduction policies

The International Society of Hypertension and World Hypertension League call on governments, nongovernmental organizations and the food industry to work to reduce dietary sodium

The International Society of Hypertension and the World Hypertension League have developed a policy statement calling for reducing dietary salt. The policy supports the WHO and the United Nations recommendations, which are based on a comprehensive and up-to-date review of relevant research. The policy statement calls for broad societal action to reduce dietary salt, thus reducing blood pressure and preventing hypertension and its related burden of cardiovascular disease. The hypertension organizations and experts need to become more engaged in the efforts to prevent hypertension and to advocate strongly to have dietary salt reduction policies implemented. The statement is being circulated to national hypertension organizations and to international nongovernmental health organizations for consideration of endorsement. Member organizations of the International Society of Hypertension and the World Hypertension League are urged to support this effort.

A Cost Effectiveness Analysis of Salt Reduction Policies to Reduce Coronary Heart Disease in Four Eastern Mediterranean Countries

BackgroundCoronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey.Methods and FindingsThree policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey.ConclusionDecreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives.

UK population salt reduction: an experiment in public health

BackgroundThe UK has implemented a programme of voluntary salt reduction in collaboration with the food industry, which has resulted in a fall in salt intake in the population. We undertook a comprehensive analysis of the programme with the aim of providing a simple step-by-step guide for development and implementation of a national salt reduction programme that other countries could follow. MethodsWe identified several key components of the UK salt reduction programme by reviewing (1) the documents archived by Consensus Action on Salt and Health (CASH) on the UK salt reduction policy, (2) journal and press articles, and (3) relevant websites. The main elements of the UK programme include (1) setting up of an action group with strong leadership and scientific credibility; (2) establishing salt intake by measuring 24-h urinary sodium in a random sample of the population and identifying the major sources of salt by dietary record; (3) setting a salt intake target for the population and developing a salt-reduction strategy; (4) setting progressively lower voluntary salt targets for over 80 categories of food, with a clear timeframe for the industry to achieve these targets; (5) working and engaging with the food industry to encourage reformulation of food to contain less salt to meet these targets; (6) introducing clear labelling of salt content in food; (7) undertaking consumer awareness campaigns; (8) monitoring progress by (a) frequent surveys and media publicity of salt content in food, including naming and shaming, and (b) repeated 24-h urinary sodium measurement at 3–5-year intervals; and (9) applying pressure through media exposure with a potential threat of regulation by the Department of Health. FindingsThe outcome of the successful implementation of the UK salt reduction programme is shown in four areas. First, product surveys over the years showed substantial reductions in the salt content in food; for example, a 20% reduction in the salt content of bread from 2001 to 2011. Second, there was an increase in consumers' awareness of the dangers of salt and an increase in the number of individuals trying to cut down on salt, with a decrease in salt use at the table and a reduction in table and cooking salt sales. Third, the mean salt intake in the population as measured by 24-h urinary sodium fell from 9·5 g per day to 8·1 g per day (15% reduction; p<0·05) during the 7 years since the salt reduction programme began in 2003–04. Fourth, the reduction in salt intake achieved in the UK was estimated to prevent about 9000 cardiovascular deaths a year, saving the UK economy more than £1·5 billion per annum. A limitation of our study was the absence of a control group. InterpretationThe UK salt reduction programme reduced the salt intake of the whole population by gradual reformulation on a voluntary basis, reinforced by strong political pressure. Several countries are already following the UK's lead. The challenge now is to spread this policy out to all other countries around the world with appropriate local modifications. A reduction in salt intake worldwide would result in major public health improvements and cost savings. FundingNone.

OP14 Cost Effectiveness Analysis of Salt Reduction Policies to Reduce Coronary Heart Disease in Syria

BackgroundCoronary heart disease (CHD) and stroke account for approximately half of all-deaths in Syria. The country’s CHD mortality rate has escalated by nearly two-thirds between 1996 and 2006, partly reflecting...

OP13 An Economic Evaluation of Salt Reduction Policies to Reduce Cardiovascular Disease in England: A Policy Modelling Study

BackgroundDietary salt intake has been causally linked to high blood pressure and increased risk of cardiovascular events. Cardiovascular disease (CVD) causes approximately 35% of total UK deaths, at an estimated...

Current salt reduction policies across gradients of inequality-adjusted human development in the WHO European region: minding the gaps.

To assess current salt reduction policies in countries of the WHO European Region against the backdrop of varying levels of human development adjusted for income, education and health (longevity) inequalities. Population-based, cross-sectional study, with data gathered through systematic review of relevant databases and supplementary information provided by WHO Nutrition Counterparts. Member States of the WHO European Region. Inequality-adjusted Human Development Index scores were analysed against assessed levels of development and implementation of national nutrition policies and initiatives targeting population-level salt reduction. Within the WHO European Region, Inequality-adjusted Human Development Index values among countries with no existing salt reduction initiatives (mean 0·643 (se 0·022)) were significantly lower than among those with either partially implemented/planned salt initiatives (mean 0·766 (se 0·017), P < 0·001) or fully implemented salt initiatives (mean 0·780 (se 0·021), P < 0·001). Where salt reduction strategies are implemented as an integral part of national policy, outcomes have been promising. However, low- and middle-income countries may face severe resource constraints that keep them from emulating more comprehensive strategies pursued in high-income countries. Care must be taken to ensure that gaps are not inadvertently widened by monitoring differential policy impacts of salt policies, particularly regarding trade flows.

Barriers for progress in salt reduction in the general population. An international study

Salt reduction is important for reducing hypertension and the risk of cardiovascular events, nevertheless worldwide salt intakes are above recommendations. Consequently strategies to reduce intake are required, however these require an understanding of salt intake behaviours to be effective. As limited information is available on this, an international study was conducted to derive knowledge on salt intake and associated behaviours in the general population. An online cohort was recruited consisting of a representative sample from Germany, Austria, United States of America, Hungary, India, China, South Africa, and Brazil (n=6987; aged 18–65years; age and gender stratified). Participants completed a comprehensive web-based questionnaire on salt intake and associated behaviours. While salt reduction was seen to be healthy and important, over one third of participants were not interested in salt reduction and the majority were unaware of recommendations. Salt intake was largely underestimated and people were unaware of the main dietary sources of salt. Participants saw themselves as mainly responsible for their salt intake, but also acknowledged the roles of others. Additionally, they wanted to learn more about why salt was bad for health and what the main sources in the diet were. As such, strategies to reduce salt intake must raise interest in engaging in salt reduction through improving understanding of intake levels and dietary sources of salt. Moreover, while some aspects of salt reduction can be globally implemented, local tailoring is required to match level of interest in salt reduction. These findings provide unique insights into issues surrounding salt reduction and should be used to develop effective salt reduction strategies and/or policies.

Salt in bread in Europe: potential benefits of reduction

Bread is widely considered to be the foodstuff that provides the most dietary salt to the diet. As such, it is one of the key public health targets for a salt reduction policy. In this respect, it has been shown that a reduction in the salt content of bread is possible, and an alternative approach involves partial replacement with other, mainly potassium-based salts, which also counteract the effects of sodium. This replacement should be undertaken on the basis of criteria that maintain the product's sensory profile, and it tends to be more successful in breads with more naturally flavorful taste. The present review was conducted to examine salt intake in Europe and the health problems associated with its excessive consumption; particular focus is placed on the salt content of bread and the effects of its possible reduction and/or correction. The beneficial effects of such changes are highlighted by way of a theoretical calculation in baguette-type wheat bread. European legislation in the field of nutrition and health claims allows the positive aspects of such salt reduction and replacement methods to be stated.

PS15 Policy Actions to Reduce Dietary Salt Intake: Price, Product, Place or Promotion? A Review of the Evidence

BackgroundA range of policies aim to reduce salt intake; however, their relative effects remain unclear. We undertook a narrative synthesis of existing evidence to determine the most promising approaches.MethodsWe searched...

Reducing the sodium content of high-salt foods: Effect on cardiovascular disease in South Africa

Average salt intake in South African (SA) adults, 8.1 g/day, is higher than the recommended 4 - 6 g/day recommended by the World Health Organization. Much salt consumption arises from non-discretionary intake (the highest proportion from bread, with contributions from margarine, soup mixes and gravies). This contributes to an increasing burden of hypertension and cardiovascular disease (CVD). To provide SA-specific information on the number of fatal (stroke, ischaemic heart disease and hypertensive heart disease) and non-fatal CVD events that would be prevented each year following a reduction in the sodium content of bread, soup mix, seasoning and margarine. Based on the potential sodium reduction in selected products, we calculated the expected change in population-level systolic blood pressure (SBP) and mortality due to CVD and stroke. Proposed reductions would decrease the average salt intake by 0.85 g/person/day. This would result in 7 400 fewer CVD deaths and 4 300 less non-fatal strokes per year compared with 2008. Cost savings of up to R300 million would also occur. Population-wide strategies have great potential to achieve public health gains as they do not rely on individual behaviour or a well-functioning health system. This is the first study to show the potential effect of a salt reduction policy on health in SA.

Leishmaniasis.

<h3>Background</h3> Dietary salt intake generates a substantial burden of cardiovascular disease (CVD) and gastric cancer. Since 2003, the United Kingdom has implemented a series of policies to reduce dietary salt by 15%. The aim of this study was to estimate the overall disease impact and equity of existing and potential national salt reduction policies on CVD and gastric cancer in England. <h3>Methods</h3> We used a validated discrete-time, dynamic, stochastic, microsimulation model (IMPACT<b>_NCD</b>) to explore the life courses of a close-to-reality synthetic population under counterfactual salt policy scenarios. The Health Survey for England and the Sodium Survey series data, with findings from high quality meta-analyses primed the model. We estimated current and future cardiovascular and gastric cancer disease incidence and mortality stratified by Index of Multiple Deprivation quintile groups. In the first period, 2003–2015, we compared the impact of the current policy against a counterfactual ‘no intervention’ scenario, which assumed salt consumption persisted at 2003 levels. For 2015–2025, we assumed additional legislative policies could achieve a steeper decline in salt consumption. We compared this against the counterfactual scenario that the downward trend in salt consumption, observed between 2001 and 2011, would continue to 2025. We incorporated probabilistic sensitivity analysis in our estimates, summarised as medians and interquartile ranges (IQR) of the model output distributions (IMPACT<b>_NCD</b> implements a second order Monte Carlo design that propagated the estimated uncertainty of model inputs to the outputs). <h3>Results</h3> Since 2003, current salt policies have prevented or postponed approximately 59,000 (IQR: 42,000 to 78,000) CVD cases and 11,000 (IQR: −3,000 to 24,000) CVD deaths. In addition, the current policies have prevented around 9,000 (IQR: 4,000 to 13,000) new cases of gastric cancer resulting in 4,000 (IQR: 1,000 to 7,000) fewer deaths. This policy had no impact on socioeconomic inequalities in CVD but increased inequalities in gastric cancer. Additional legislative policies from 2015 could further prevent or postpone approximately 18,000 (IQR: 3,000 to 33,000) CVD cases and 3,000 (IQR: −6,000 to 12,000) deaths by 2025, while reducing inequalities. Similarly for gastric cancer 3,000 (IQR: −1,000 to 7,000) cases and 1,000 (IQR: −1,000 to 4,000) deaths could be prevented or postponed with neutral impact on inequalities. <h3>Conclusion</h3> Current salt reduction policies are powerfully effective in reducing the cardiovascular and gastric cancer disease burdens overall but fail to reduce the inequalities involved. However, additional structural policies could achieve further reduction in disease incidence and more equitable health benefits.