The FDA’s voluntary sodium reduction goals for packaged and processed foods could greatly reduce or delay deaths from cardiovascular disease (CVD) in the U.S. and are cost-saving even in pessimistic simulations, according to a study published online April 10 in PLOS Medicine.
Americans consume an average of 3,400 milligrams of sodium per day, about 50 percent above the recommended upper limit of 2,300 mg/day, wrote lead researcher Jonathan Pearson-Stuttard, BMBCh, and colleagues. Because about 75 percent of sodium intake comes from processed and commercially produced foods, the FDA in 2016 challenged food manufacturers to reformulate their products to meet two-year and 10-year sodium reduction goals.
Similar policies have been effective in Finland, Turkey and the United Kingdom, the authors noted, leading to long-term reductions in sodium consumption as well as reduced downstream adverse events related to hypertension and CVD.
“Gradual sodium reduction achieves mean population sodium intake reductions without noticeable changes to consumers and their palates,” wrote Pearson-Stuttard, with the School of Public Health at Imperial College London, and colleagues. “This is unlikely to trigger compensatory behaviors resulting in additional sodium used by the consumer at the table or in cooking.”
The researchers estimated the health and economic impact of the FDA’s sodium reduction goals under three scenarios: optimal, meaning 100 percent industry compliance with 10-year reformulation targets; moderate, 50 percent compliance with 10-year targets; and pessimistic, 100 percent compliance with two-year targets, but no additional progress.
If the optimistic scenario were achieved, the researchers estimated approximately 450,000 cases of CVD could be prevented from 2017 to 2036. The U.S. population would gain about 2.1 million quality-adjusted life years (QALYs) over this span and cost savings would equal $41 billion.
Even in the moderate and pessimistic scenarios, 1.1 million and 0.7 million QALYs would be gained, respectively, and savings would be $19 billion and $12 billion. Cost savings was calculated as healthcare savings—including formal and informal care costs and lost productivity—minus the cost of administering the policy changes as well as industry costs to reformulate products.
“The optimal scenario saved the most lives and generated the most QALYs and economic savings,” the researchers wrote. “However, even lower compliance, i.e., with just the 2-year targets or 50 percent of the 10-year targets, yielded health and cost savings. This finding highlights the substantial health and economic opportunity costs of inaction or poorly sustained efforts to reduce sodium consumption.”
Using a willingness-to-pay threshold of $100,000 per QALY, the authors found that all of the scenarios would be cost-effective by 2021 and become cost-saving by 2031. In addition, they noted the policy would be more impactful for certain groups.
“The absolute health benefits from the optimistic scenario would be approximately 50% greater among men than among women, reflecting men’s higher sodium intake and higher CVD burden,” Pearson-Stuttard et al. wrote. “The benefit would also be greater among non-Hispanic black individuals than among non-Hispanic white individuals, reflecting the higher SBP (systolic blood pressure), higher CVD burden, and greater sensitivity to sodium changes of black individuals. Finally, the largest number of CVD cases would be prevented in the oldest age group (70–84 years), while middle-aged individuals (50–69 years) would gain the most QALYs.”
The authors noted their analysis was limited because it only evaluated conditions mediated through blood pressure, even though eating less sodium could also reduce the burden of other diseases such as gastric cancer. Also, their effect estimates were based on interventional and prospective observational studies, leaving their projection models open to the same potential bias and confounding from those original studies.
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.