Policies that address the food environment at the population level may help prevent chronic disease, but their value to society is still uncertain. Dietary sodium is linked to increased prevalence of hypertension, a primary risk factor for cardiovascular and renal diseases. This study calculates the potential societal savings of reducing hypertension and related cardiovascular disease via a reduction in population-level sodium intake. On average, U.S. adults consume almost twice the recommended maximum of dietary sodium, most of it from processed foods.
This study modeled sodium-reduction scenarios by using a cross-sectional simulation approach. The model used population-level data on blood pressure, antihypertensive medication use, and sodium intake from the National Health and Nutrition Examination Survey (1999-2004). This data was then combined with parameters from the literature on sodium effects, disease outcomes, costs, and quality of life to yield model outcomes.
This study calculated the following outcome measures: hypertension prevalence, direct health care costs, and quality-adjusted life years for noninstitutionalized U.S. adults.
The simulation was conducted with STATA 9.2 and Microsoft Excel. Survey weights were used to calculate population averages.
Reducing average population sodium intake to 2300 mg per day, the recommended maximum for adults, may reduce cases of hypertension by 11 million, save $18 billion health care dollars, and gain 312,000 QALYs that are worth $32 billion annually. Greater reductions in population sodium consumption bring even greater savings to society.
Large benefits to society may result from efforts to lower sodium consumption on a population level by modest amounts over time. Although savings in direct health care costs are likely to be quite high, they could easily be matched or exceeded by the value of quality-of-life improvements.
"the risks associated with an increase in salt consumption, chiefly those related to an increase in blood pressure, are linear  . Most health economic models input relatively small changes in blood pressure that occur in those with normal and high blood pressure as estimated by short-term modest reductions in dietary sodium   . Some models also include the gastric cancers that are positively associated with, and probably caused by, high-salt intake . "
[Show abstract][Hide abstract] ABSTRACT: Excess intake of dietary salt is estimated to be one of the leading risks to health worldwide. Major national and international health organizations, along with many governments around the world, have called for reductions in the consumption of dietary salt. This paper discusses behavioural and population interventions as mechanisms to reduce dietary salt. In developed countries, salt added during food processing is the dominant source of salt and largely outside of the direct control of individuals. Population-based interventions have the potential to improve health and to be cost saving for these countries. In developing economies, where salt added in cooking and at the table is the dominant source, interventions based on education and behaviour change have been estimated to be highly cost effective. Regardless, countries with either developed or developing economies can benefit from the integration of both population and behavioural change interventions.
"As reported by the National Health and Nutrition Examination Survey (NHANES) of 2005–2006, sodium intake by US consumers is approximately 3,366 mg/d (Gunn et al., 2010). The potential savings due to reduction in sodium by reducing hypertension and related cardiovascular disease has been reported to be significant, regarding societal well-being (quality of life) and savings in billions of dollars in medical costs (Palar and Sturm, 2009; Bibbins-Domingo et al., 2010; Smith-Spangler et al., 2010). "
[Show abstract][Hide abstract] ABSTRACT: Reducing the sodium content in cheese is expected to contribute to reducing the overall intake of sodium by US consumers. The purpose of this study was to measure the sodium levels in cheeses that are most commonly purchased by US consumers in the retail market, including brand and private label. A secondary purpose of the study was to generate data that can enable the dairy industry to adopt best practices regarding sodium levels in cheeses. The sodium content of a total of 1,665 samples of Cheddar (650 samples), low moisture part skim (LMPS) Mozzarella (746 samples), and process cheese singles (269 samples) from 4 geographical regions were collected over a period of 3 wk, and were analyzed over a 1-mo period. Process cheese contained the highest mean level of sodium (1,242 mg/100g), followed by string cheese (724 mg/100g). Across Cheddar cheese forms and brands, the mean analytical sodium was 615 mg/100g, with 95% between 474 and 731 mg/100g; label sodium ranged from 600 to 800 mg/100g (mean 648 mg). Across all LMPS Mozzarella forms and brands, the mean analytical sodium was 666 mg/100g, with 95% between 452 and 876 mg/100g; label sodium ranged from 526 to 89 3mg/100g (mean 685 mg). Across all process cheese forms and brands, the mean analytical sodium was 1,242 mg/100g, with 95% between 936 and 1,590 mg/100g; label sodium ranged from 1,185 to 1,740 mg/100g (mean 1,313 mg/100g). These findings demonstrate that manufacturers tended to be conservative with their reporting of sodium on labels. Manufacturers need to reduce variability to better target desired sodium levels, which is an opportunity for better process control, and will enable them to label sodium more accurately.
[Show abstract][Hide abstract] ABSTRACT: Resistant hypertension, defined as uncontrolled blood pressure (BP) in spite of the use of at least three antihypertensive medications, ideally including a diuretic, is an increasingly common problem. Observational studies indicate a significant association between dietary salt and level of BP. In subjects with mild–moderate hypertension, ingestion of a low-salt diet promotes modest reductions in BP. Patients with hypertension resistant to treatment are particularly salt sensitive. The degree of BP reduction induced by dietary salt restriction in this group of subjects is considerably larger than reductions observed in the general population of hypertensive subjects and may be similar to adding two antihypertensive agents. In a randomized and crossover study of patients with resistant hypertension, a low-sodium diet (50 mmol/day) for 7 days reduced office systolic and diastolic BP by 22.7 and 9.1 mmHg, respectively, compared with a high-sodium diet (250 mmol/day). Reduction in intravascular volume and improvement in vascular stiffness may contribute to the favorable BP effects of dietary salt reduction in patients with resistant hypertension. Intensive dietary salt restriction should be considered for inclusion in the clinical management of patients with resistant hypertension.
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