Salt: Mandatory Limits Would Give Most Benefits

November 05, 2010

November 5, 2010 (Herston, Australia) — Imposing statutory limits on the salt content of processed foods could be 20 times more effective than voluntary restrictions in terms of the impact on cardiovascular health, a new study in Australia has found [1].

In their paper published online November 1, 2010 in Heart, Dr Linda J Cobiac (University of Queensland, Herston, Australia) and colleagues note that many countries, including Australia, the UK, Canada, France, Finland, and New Zealand have implemented salt-reduction programs, but that most of these rely on voluntary changes by food manufacturers and informed choice by consumers. "It is argued that legislative enforcement of salt limits in food processing is needed to achieve meaningful changes in population salt levels," they observe.

In their study, they assessed the public-health benefits and cost-effectiveness of three strategies for reducing dietary sodium content, including the current Australian "Tick" program. This entails food manufacturers being able to buy an endorsed logo for use on packaging to try to achieve higher sales in return for voluntarily reducing the salt content of the endorsed products. They also examined the impact of two other possible interventions: mandatory reductions in sodium content and professional advice to cut dietary salt for those at increased and high risk of cardiovascular disease.

They calculated the cost-effectiveness ratios in Aus$ (for the year 2003) per disability-adjusted life-years (DALYs) for the strategies--adding in various other variables, such as government/food industry costs and costs of unrelated healthcare in added years of life--and compared the results with what would happen if none of these strategies were in place.

Interventions that came out as "dominant" led to more health and less cost than if no intervention to reduce salt was in place: they found that providing dietary advice to reduce salt intake was not cost-effective, even if directed toward those with the highest blood pressure who are most at risk of cardiovascular disease.

Voluntary industry restrictions on the salt content of processed foods under the current Australian incentive scheme were cost-effective, however, and would cut ill health from cardiovascular disease by almost 1%, which is substantial at the population level, they point out.

But in order to achieve significant improvements in population health, government legislation to reduce sodium should be enacted in Australia, which could generate an 18% reduction in morbidity from cardiovascular disease, they calculate.

"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," they conclude.

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