Priority Actions to Advance Population Sodium Reduction

Abstract

High sodium intake is estimated to cause approximately 3 million deaths per year worldwide. The estimated average sodium intake of 3.95 g/day far exceeds the recommended intake. Population sodium reduction should be a global priority, while simultaneously ensuring universal salt iodization. This article identifies high priority strategies that address major sources of sodium: added to packaged food, added to food consumed outside the home, and added in the home. To be included, strategies needed to be scalable and sustainable, have large benefit, and applicable to one of four measures of effectiveness: (1) Rigorously evaluated with demonstrated success in reducing sodium; (2) suggestive evidence from lower quality evaluations or modeling; (3) rigorous evaluations of similar interventions not specifically for sodium reduction; or (4) an innovative approach for sources of sodium that are not sufficiently addressed by an existing strategy. We identified seven priority interventions. Four target packaged food: front-of-pack labeling, packaged food reformulation targets, regulating food marketing to children, and taxes on high sodium foods. One targets food consumed outside the home: food procurement policies for public institutions. Two target sodium added at home: mass media campaigns and population uptake of low-sodium salt. In conclusion, governments have many tools to save lives by reducing population sodium intake.

Availability, Formulation, Labeling, and Price of Low-sodium Salt Worldwide: Environmental Scan

“…The approach of integrating low-sodium salts as a public health intervention can potentially reduce dietary sodium intake at the population level through reformulating manufactured foods with low-sodium salts, replacing cooking salt used at home or in restaurants with low-sodium salts, or a combination thereof. Thus, population uptake of low-sodium salts has been recommended as one of seven priority strategies to reduce population sodium consumption [ 11 ].…”

Receiving advice from a health professional and action taken to reduce dietary sodium intake among adults

“…Reducing actual Na intake may be difficult for even highly motivated consumers to achieve, given the ubiquity of added Na in the US food supply (16) . For this reason, reducing Na added to the food supply and expanding access to lower-Na food options are needed to assist consumers in lowering their Na intake (4,17) . Public health professionals and food industry partners can use data from the BRFSS optional Na module to demonstrate that the majority of adults report taking action to reduce Na intake, demonstrating potential demand for policies, interventions and products that facilitate Na reduction efforts.…”

Cultural Perspectives on Sodium Intake Reduction Among Nigerians in the US: An Application of the PEN-3 Model

“…reformulation of industrially produced foods, 2) consumer awareness and education, and 3) national policies that target standards for food manufacturers and providers (3,4,13). The product reformulation strategy supports sodium intake reduction through collaboration with food producers and distributors to control sodium content of packaged foods and out-of-home or restaurant foods.…”

“…The Global Burden of Disease study of 2017 showed that the leading contributors to NCD-related morbidity and mortality were cardiovascular diseases such as high blood pressure, stroke, coronary heart disease, and heart failure (2). Of these, high blood pressure is one of the most significant (3). High blood pressure develops from complex and interrelated factors, including those related to modifiable behavior and lifestyle (4).…”

“…The World Health Organization (WHO) recommends a daily sodium consumption of less than 2 grams (or <5 g salt/d). If adhered to, this recommendation would prevent an estimated 2.5 million deaths from NCDs worldwide (3). Dietary sodium comes from 3 distinct sources: packaged foods, food prepared outside the home (eg, restaurants), and additional discretionary sources (adding salt to foods prepared at home during cooking or eating) (4).…”