Cost-Effective Efforts to Reduce Salt in Large Populations

This study was conducted to assess the cost benefits of population strategies to reduce salt intake in the diet. The results showed that the methods used, namely voluntary reduction and mandatory reduction of salt used by the food industry, are both cost beneficial in reducing the risk of heart disease in the general Australian population. On the other hand, providing advice to the population does not seem to work toward a cost-effective goal. The authors conclude, “the population health benefits could be 20 times greater with government legislation on moderate salt limits in processed foods.”

Heart disease kills millions of people worldwide and is estimated to be the cause of death for at least 23 million people a year by 2030. Hypertension or high blood pressure is one of the factors for risk of death from heart disease, heart attacks and strokes. Hypertension also accounts for 10 percent of the global spending on health care. It is known that high salt levels in the diet triggers blood pressure to a higher value. Efforts are being taken to restrict the salt intake of people with high blood pressure. Most experts recommend salt intake of 6 g or less per day for a person with high blood pressure. In Australia, various measures are being taken to reduce the salt intake in the general population. This includes dietary advice to people and voluntary and mandatory salt regulations by food industries in their products. This study attempted to see the cost benefits of such measures.

* This study used complex statistical tests to project the outcome of heart disease in the general Australian population in 2030.
* The researchers studied the effects of voluntary salt restrictions in processed foods by manufacturers. They also assessed the outcome of government legislation to reduce the salt levels in processed foods.
* Finally, they assessed the effectiveness of the advice of health care workers to patients with high blood pressure and the high-risk population to reduce salt in their diet.
* To assess the cost-effectiveness, the researchers measured disability-adjusted life years avoided over a person’s life and thus, the saving on healthcare expenditure by reducing salt in the diet.

Key findings
* The results showed that both voluntary and mandatory reduction of salt levels in processed foods by manufacturers were cost-effective in reducing disability-adjusted life years.
* Government legislation and mandates to reduce salt in processed foods was found to be 20 times more cost-effective than voluntary moderation in salt addition to the processed foods by the food manufacturers.
* However, diet advice to patients and the high-risk population was not cost beneficial, even if only targeted at patients with the highest blood pressure.

Next steps/Shortcomings
The authors admit some lacunae in their research design. While the authors measured the amount of salty food and salt purchased by the studied individuals over one year, they failed to assess the exact amount that was consumed by the study population. They suggest studies to detect the precise effects of intervention on the selected population over their lifetime to determine their cost-effectiveness.

This study shows that government regulations in reducing the salt in the diet by food manufacturers is a cost-effective measure to reduce the loss of productive work brought on by heart disease in a population’s lifetime. The authors found that voluntary reduction of salt used by the industry is also cost-effective, but providing dietary advice to high-risk individuals is not cost-effective. The authors speculate that other food measures that include addition of vital nutrients like folic acid in processed foods are more difficult measures, but reducing the salt in processed foods is easier, with many reductions not noticed by consumers as they get used to low-salt food over a period of time. The authors conclude, “Programs to encourage the food industry to reduce salt in processed foods are highly recommended for improving population health and reducing health sector spending in the long term.”

For More Information:
Cost-Effectiveness of Interventions to Reduce Dietary Salt Intake
Publication Journal: Heart, 2010
By Linda Cobiac; Theo Vos; University of Queensland, Herston, Australia

*FYI Living Lab Reports Are Summaries of the Original Research.

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