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Mandatory sodium reduction 20 times more effective, finds study

By Caroline Scott-Thomas , 02-Nov-2010

Imposing mandatory sodium limits for processed foods could be 20 times as effective as voluntary reduction measures, suggests a new study published in the journal Heart.

The study examined the comparative cost-effectiveness of either enforcing sodium limits for the food industry or voluntary reduction measures, in terms of resultant public health outcomes.

The authors wrote: “Simulations in the USA even suggest that achieving a salt reduction of 3 g/day in the American diet (approximately 29 percent of daily intake for men and 41 percent for women) could benefit public health more than targeting tobacco, weight loss or cholesterol levels, and prevent as many deaths as antihypertensive drugs would prevent if given to everyone with hypertension.

“It is not clear, however, if salt reductions of this magnitude are achievable with current measures that rely on voluntary changes by food manufacturers and informed choice by consumers.”

The researchers examined four possible interventions to reduce sodium consumption in Australia: The current ‘Tick’ program in use across the country, which provides incentives for food manufacturers to voluntarily reduce sodium in their products; legislation and enforcements mandating that manufacturers stick to the Tick program limits; dietary advice for everyone at increased risk of cardiovascular disease; and dietary advice for everyone at high risk.

They found that providing dietary advice was the least cost-effective measure. Even if directed at those with the highest blood pressure readings and those at greatest risk of developing high blood pressure, such advice “would avert less than 0.5 percent of this disease burden.”

But they also found that the current voluntary Tick program averts less than one percent.

“Making Tick limits mandatory for all bread, margarine and cereal products, however, could avert 18 percent of the disease burden, which is 20 times the health gain achieved with the voluntary approach,” they wrote.

The researchers said that despite the increased effectiveness of mandatory sodium reduction, there are important ethical considerations to take into account, in terms of how much control the state should have over individuals’ diets. However, they claim that such intervention is justified because of the large proportion of the population that consumes too much salt; children and sectors of society with least access to health care would also benefit; and unlike regulation of other ingredients, such as iodization of salt or folic acid in bread, such legislation would not add anything to the food supply.

"There is no evidence of harm from small and gradual salt reductions,” they wrote. “…Food manufacturers have a responsibility to make money for their shareholders, but they also have a responsibility to society. If corporate responsibility fails, maybe there is an ethical justification for government to step in and legislate.”

Source: Heart

doi:10.1136/hrt.2010.199240

“Cost-effectiveness of interventions to reduce dietary salt intake”

Authors: Linda J Cobiac, Theo Vos, J Lennert Veerman

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