Public health impact of salt reduction

M.A.H. Hendriksen

Research output: Thesisinternal PhD, WU

Abstract

The health and economic burden related to cardiovascular diseases is substantial and prevention of these diseases remains a challenge. There is convincing evidence that high salt intake affects blood pressure and the risk of cardiovascular diseases. As salt intake is far above the recommended maximum level of intake, salt reduction may help to reduce cardiovascular disease incidence. However, the effect of salt reduction initiatives on intake levels and long-term health is largely unknown. The main aim of the research described in this thesis is to assess salt intake and the potential health impact of salt reduction in the Netherlands and in Europe. This is addressed by estimating the potential effect of salt reduction strategies on salt intake, by monitoring the effect of the ongoing salt reduction initiatives in the Netherlands between 2006 and 2010 on daily salt intake and by projecting the expected long-term health benefits of salt reduction in the Netherlands and Europe. 

Firstly, we used data from the Dutch National Food Consumption Survey 2007-2010 and the Dutch Food Composition Database 2010 to study the effect of two potential salt reduction scenarios on salt intake from processed foods. In the first scenario, sodium levels in processed foods were reduced towards their minimum feasible sodium level. In the second scenario, foods were substituted by a low-salt alternative within the same food category. This study demonstrated that daily salt intake from foods could be reduced below the recommended maximum intake of 6 g/d, provided these strategies are successfully implemented.

Secondly, the effect of the ongoing salt reduction initiatives in the Netherlands between 2006 and 2010 was evaluated. Dutch adults in two cross-sectional studies (n=317 in 2006 and n=342 in 2010) collected a single 24h urine sample. Despite the initiatives of the food industry to reduce sodium levels in processed foods, no statistically significant difference in daily salt intake was observed between 2006 (8.7 g/d) and 2010 (8.5 g/d).

Thirdly, the long-term health impact of salt reduction was assessed for the Netherlands using the RIVM Chronic Disease Model and for Europe using the Dynamic Model for Health Impact Assessment (DYNAMO-HIA). A two-step approach was used: the effect of salt reduction on blood pressure was estimated, which was subsequently translated into occurrence of cardiovascular diseases. Substantial changes in incident stroke (6.0%) and acute myocardial infarction (4.4%) can be expected in the Netherlands if sodium contents in processed foods were reduced to the minimum feasible level. The potential health impact of population-wide adherence to the salt intake guideline of the World Health Organization (maximum of 5 g/d) ranged for nine European countries between 10.1% in Finland to 23.1% in Poland for stroke, and between 6.6% in Finland to 15.5% in Poland for ischemic heart diseases.

Finally, a methodological comparison of seven population health models on salt reduction revealed that these models vary in underlying assumptions. We demonstrated that these differences in assumptions may substantially affect the health impact estimates.

In conclusion, technologically feasible salt reductions in processed foods or changes in dietary behaviour may, if implemented successfully, lead to a substantial lowering of daily salt intake, and thereby contribute to considerable health gain. Cross-country comparisons of health impact of salt reduction strategies might benefit from more transparency on the necessary assumptions in the various population health impact models for salt reduction used worldwide.  

 

Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Wageningen University
Supervisors/Advisors
  • Boshuizen, Hendriek, Promotor
  • van Raaij, Joop, Co-promotor
  • Geleijnse, Marianne, Co-promotor
Award date26 Oct 2015
Publisher
Print ISBNs9789462575462
Publication statusPublished - 2015

Keywords

  • salt
  • iodized salt
  • intake
  • reduction
  • health
  • nutrition and health
  • modeling
  • cardiovascular diseases
  • hypertension
  • europe

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