Modeled changes in US sodium intake from reducing sodium concentrations of commercially processed and prepared foods to meet voluntary standards established in North America: NHANES

Abstract

Background: Approximately 2 in 3 US adults have prehypertension or hypertension that increases their risk of cardiovascular disease. Reducing sodium intake can decrease blood pressure and prevent hypertension. Approximately 9 in 10 Americans consume excess sodium ($2300 mg/d). Voluntary sodium standards for commercially processed and prepared foods were established in North America, but their impact on sodium intake is unclear. Objective: We modelled the potential impact on US sodium intake of applying voluntary sodium standards for foods. Design: We used NHANES 2007-2010 data for 17,933 participants aged $1 y to model predicted US daily mean sodium intake and the prevalence of excess sodium intake with the use of the standards of the New York City's National Salt Reduction Initiative (NSRI) and Health Canada for commercially processed and prepared foods. The Food and Nutrient Database for Dietary Studies food codes corresponding to foods reported by NHANES participants were matched to NSRI and Health Canada food categories, and the published sales-weighted mean percent reductions were applied. Results: The US population aged $1 y could have reduced their usual daily mean sodium intake of 3417 mg by 698 mg (95% CI: 683, 714 mg) by applying NSRI 2014 targets and by 615 mg (95% CI: 597, 634 mg) by applying Health Canada's 2016 benchmarks. Significant reductions could have occurred, regardless of age, sex, race/ethnicity, income, education, or hypertension status, up to a mean reduction in sodium intake of 850 mg/d in men aged $19 y by applying NSRI targets. The proportion of adults aged $19 y who consume $2300 mg/d would decline from 88% (95% CI: 86%, 91%) to 71% (95% CI: 68%, 73%) by applying NSRI targets and to 74% (95% CI: 71%, 76%) by applying Health Canada benchmarks. Conclusion: If established sodium standards are applied to commercially processed and prepared foods, a significant reduction of US sodium intake could occur.Am J Clin Nutr 2017;106:530-40.

Simulating the impact of sodium reduction from packaged foods on population sodium intake in US adults and children

“…Modelling studies have also shown that if the NSRI targets were to be met by all food companies, that Non-Hispanic Whites would have the largest reduction in stroke incidence and mortality (24) . The most recent US-based modelling study found that if the 2014 NSRI targets were met, that the US population >1y could reduce sodium intake by 20% (28) , which is a much larger reduction predicted than our current findings which indicate that even with across-the-board reductions in the sodium content of packaged foods, sodium intake would not be reduced by more than 13%. However, our analysis simulates the reductions that could be achieved if packaged storebought foods alone had levels reduced, and do not take into account the impact that would be seen if sodium levels in foods consumed from restaurants or take-away foods were also reduced.…”

The impact of food reformulation on nutrient intakes and health, a systematic review of modelling studies

“…Overall, studies were heterogeneous in the way interventions and outcomes were modelled and reported, limiting between-study comparisons. As regards the type of nutrient reformulated, 20 studies focused exclusively on sodium reduction (60.6%) [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41], followed by 5 studies considering at least 2 different nutrients (15.1%) [8,[42][43][44][45], 5 studies addressing sugar (15.1%) [46][47][48][49][50] and 3 study addressing fat (9%) [11,51,52].…”

“…Target foods in the included studies were all processed foods (n = 9) [27,31,33,37,38,41,45,51,52], selected groups of nutrient-dense foods (n = 8) [11, 26, 34-36, 43, 44, 50], or single food products (n = 8) [23,24,42,[46][47][48][49]. Four studies provided estimates for more than one item [8,[28][29][30], whereas in 4 studies target foods were not specified since reformulation was modelled directly through its assumed effect on intake [22,25,32,39].…”

“…Four studies provided estimates for more than one item [8,[28][29][30], whereas in 4 studies target foods were not specified since reformulation was modelled directly through its assumed effect on intake [22,25,32,39]. Ten studies simply estimated changes in intake following reformulation (30.3%) [8,11,26,33,42,43,45,49,50,53], whereas other studies estimated effects on health outcomes (n = 12, 36.4%) [25, 31, 35, 37, 39-41, 44, 46-48, 51] or health related quality of life measures (n = 11, 33.3%) [22-24, 28-30, 32, 34, 36, 38, 52].…”

“…Ten studies used cohort Markov models [22, 23, 28-30, 32, 36-38], or individual level micro-simulations [31]. Finally, 13 records, accounting for almost 40% of the included studies, used mathematical-statistical models to estimate the potential change in intake by linking cross-sectional, individual-level consumption data to the nutrient-density of foods before and after reformulation [8,11,24,26,33,42,43,45,46,[48][49][50]53]. In the majority of this last group, time was not explicitly considered, since the analysis was limited to a re-assessment of past individual intakes after reformulating all or a specific set of products.…”