The United States can learn from the global salt problem

Over the past decades, the evidence for the harmful health effects of sodium has grown overwhelmingly. Numerous and diverse studies in humans and animals have consistently shown that excessive sodium intake increases blood pressure, which is a major risk factor for cardiovascular disease (CVD). Indeed, a global study of dietary risk factors associated with poor health and death found that excessive sodium intake was a key risk factor, accounting for an estimated 2 million deaths in 2019.

Many people eat a lot more sodium than they realize, because around 70% of the sodium we consume has already been added to products such as breads, breakfast cereals, processed meats and convenience foods. , in addition to food from restaurants and fast food outlets. food outlets. The World Health Organization (WHO) recommends consuming no more than 2,000 mg of sodium per day, but intakes worldwide are much higher than that – up to double in some countries – and in the United States. United, the average intake is 3,400 mg / day.

In the United States, the question becomes: Do recent efforts to reduce sodium consumption go far enough, and what can we learn from global efforts to achieve this goal?

The best approach to reducing sodium intake

Simply telling people to eat less sodium will not be effective if all the foods people eat already have it. This is where public health policies come in: the best policy to reduce sodium intake is to set sodium reduction goals.

The concept behind the goals is that food manufacturers and chefs gradually lower the sodium levels they add to their products and dishes to meet this target level. Ideally, the targets should then be reset to a lower level to continue this process. And over time, sodium levels in products and meals will be low enough to help people reduce sodium intake. When sodium is lowered in this gradual and gradual manner, our taste buds adapt to the changing taste of the products, so we can continue to buy the same products as always. A win-win for public health, food companies and consumers.

FDA sodium reduction targets

In October, the United States began the process of implementing national sodium reduction targets with the release of sodium reduction targets, joining more than 90 countries in the global effort to reduce intake. sodium.

The FDA’s sodium reduction targets cover more than 150 food categories, which the food industry will work toward on a voluntary basis by 2023. These targets aim to reduce the average sodium intake to 3,000 mg / day. Although this is obviously higher than the limit recommended by the WHO, it is a good intermediate objective that will allow monitoring and evaluation of the impact of the targets.

The UK sodium reduction program

This approach of setting sodium reduction targets is based on the UK’s reduction program, which was established in 2006. The UK has set targets for over 80 food categories and then reset targets in 2009, 2011, 2014 and 2020. The sodium levels in many food products have decreased by 20 to 40%, which has led to a significant drop in the sodium intake of the population, in the mean blood pressure of the population. population and CVD deaths. The same could be possible in the United States, but to be successful the FDA would have to learn important lessons from the experience of the United Kingdom.

Voluntary public health policies, like the FDA goals, only succeed with clear political leadership and transparent monitoring. Britain’s sodium reduction program was initially overseen by the independent Food Standards Agency (FSA), which issued regular monitoring reports and called on companies that had not made progress. Over the past few years, however, the UK government has steadily transferred responsibility for sodium reduction between various departments, which has helped slow progress.

Along with the targets, the UK has implemented other measures that have helped support the sodium reduction target. In 2013, the government released guidelines to standardize front-of-package color-coded nutrition labels, which are now displayed on three out of four packaged products. Products should display a red color if they are high in salt (more than 1.5g per 100g or more than 1.8g per serving), which has encouraged many companies to reduce salt levels to avoid the red label. The FSA also developed a public awareness campaign, which ran on television, radio and billboards from 2004 to 2009. This initially helped build support for reduction efforts. sodium, although awareness of the problem has gradually waned over the years, demonstrating the transient nature of such campaigns.

Mandatory or voluntary sodium reduction

Importantly, the FDA must be prepared to introduce mandatory targets if progress towards voluntary policies is weak. South Africa already has mandatory targets in place for a whole range of products. These were announced in 2013 and implemented in 2016, and by that time around two-thirds of the products had already been reformulated to reduce sodium content and meet targets. Recent evidence shows that the average sodium intake of the population in South Africa has decreased by 460 mg / day, which is a huge success in the sodium reduction world.

Since the US food industry is larger and more diverse than the UK, a mandatory program may be needed in the long term to create a level playing field, ensuring that all businesses are held accountable and move towards the same standard.

Overall sodium reduction

In 2013, the WHO highlighted sodium reduction as a key goal to prevent cardiovascular disease and challenged all member states to reduce sodium intake of the population by 30% by 2025. For To help spur progress towards this goal, the WHO earlier this year released Global Benchmarks to give a baseline to all countries that have not yet set sodium reduction targets and provide more specific guidance for countries with targets in place. However, to date, no country is on track to achieve the kind of reduction in sodium intake of the population needed to have sufficient impact.

Reducing sodium intake to the recommended level could prevent millions of deaths worldwide and save thousands of dollars in healthcare costs. We need to move faster, with strong and ambitious sodium reduction policies. Hopefully the FDA is up to the challenge.

Mhairi Brown, RNutr, is a Registered Nutritionist and Program Manager for World Action on Salt, Sugar and Health (WASSH), a group of research and advocacy experts based at Queen Mary’s University in London. Feng He, PhD, is Professor of Global Health Research at Queen Mary University, London. Graham MacGregor is Professor of Cardiovascular Medicine at Queen Mary University, London and President of WASSH.

Disclosures

Mhairi is funded by the Medical Research Council / UK Research and Innovation under the Newton Fund Impact Scheme Call and Vital Strategies. Feng and Graham are both partially funded by the National Institute for Health Research (NIHR) which uses UK aid from the UK government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the MRC, NIHR, Vital Strategies or the UK Department of Health and Welfare.

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