Reduced Salt in Food Could Save Lives and Money, Study Shows
A voluntary effort by the service of the U.S. food industry to reduce salt in processed food could have serious consequences for the health of the U.S. population, prevention of strokes and heart attacks in nearly a million Americans and saving 32.1 billion U.S. dollars in medical costs, according to a new study by researchers at the School of Medicine at Stanford University and Veterans Affairs Palo Alto Health Care System.
In the study, the researchers developed a computer model that simulates the effects of reduced sodium intake in a large population of people between the ages of 40 and 85. Based on a similar campaign to reduce salt in the UK, the researchers calculated that a cooperative effort of the industry could lead to a decrease of 9.5 percent in the U.S. salt intake.
That, in turn, lead to a modest reduction in blood pressure among American consumers, while minimizing a risk factor for cardiovascular problems.
“In our analysis, we found these small decreases in blood pressure could be effective in reducing deaths from cardiovascular disease,” said Crystal Smith-Spangler, MD, a postdoctoral scholar at the VA and first author of the study. “The number of people affected is huge, so even a small decline is significant if you have a large number of people involved.”
According to the researchers’ calculations, some 513,885 Americans would be safe from the potentially fatal stroke in their lives and some 480,358 heart attacks not as a result of the salt campaign. Results will be published in the Annals of 2 March of Internal Medicine.
The study comes at a time when there is much interest in both the U.S. and abroad, in regulating the salt content in food as a way to lower blood pressure and improve health outcomes. High blood pressure remains a major public health problem in the United States, with about 73 million Americans – or one in three adults – are believed to suffer from the condition, which accounted for 73.4 billion U.S. dollars in costs health in 2009, according to a recent report by the Institute of Medicine.
Many clinical studies have shown that limiting consumption of people of salt reduces blood pressure, Smith-Spangler said. Most Americans consume more salt than is recommended, with 75 percent falling into more than the recommended maximum of 2.3 grams per day, Thomas Frieden, MD, MPH, director of the Centers for Disease Control and Prevention Diseases, said in an editorial accompanying the study.
“After controlling snuff, the most cost-effective intervention for control of chronic diseases (such as cardiovascular disease) might be to reduce sodium intake,” wrote Frieden.
He noted that the UK began working with manufacturers in 2003 to reduce salt content in food, resulting in a decrease of 20 to 30 percent of salt in processed foods sold in stores. Japan, Finland, Ireland, Australia and Canada have recently launched similar initiatives, he said.
In January, the city of New York presented a broad health initiative to encourage food manufacturers and restaurant chains to reduce their salt use by 25 percent over the next five years. The Institute of Medicine has also asked the U.S. Centers for Disease Control and Prevention and state and local governments to develop new strategies to reduce dietary sodium.
Smith-Spangler, who is also a postdoctoral scholar at the Center of Stanford University in Health Policy, said the Stanford researchers were inspired by the experience of the UK to investigate whether a similar campaign in the United States could be profitable and worthwhile.
“Based on our data, it appears that it might be worth it because it’s cheap and because cardiovascular disease is a big problem, and hypertension is a risk factor for cardiovascular disease,” he said. “Even small reductions in risk worth can have benefits for the population.”
In the study, researchers used data from a variety of sources, including the Framingham Heart Study and the 2006 Medical Expenditure Panel Survey, to develop a hypothetical model of health benefits and costs of two different methods to reduce the intake of Large-scale salt. One of them was a voluntary industry program, while the other was a tax on consumption of salty foods in government.
The collaboration of industry, they found, would reduce salt consumption by 9.5 percent, enough to reduce blood pressure by a modest 1.25 millimeters of mercury (mm Hg) in the age group studied. This reduction would extend the lives of Americans by a collective 1.3 million years during the life of the group studied, researchers estimate. It also would save 32.1 billion U.S. dollars, including $ 14 billion in hospitalizations for strokes and heart attacks.
The researchers estimated that the tax would have less impact sodium, resulting in a decrease of 6 percent in salt intake and a reduction of 0.93 mmHg in blood pressure. That would translate to 327,892 and 306,173 fewer strokes than heart attacks, calculated. However, the viability of this option seems less realistic, Smith-Spangler, said.
She said investigators do not consider some of the unintended consequences of a campaign of salt. Manufacturers use salt to make their products attractive to consumers, with less salt, consumers can turn to fat instead of improving the taste, therefore eliminating the potential benefits, he said. These and other possible health impacts of the campaign should be carefully monitored, he said.
His colleagues in the study are Jessie Jussola, MS, Stanford in the Department of Management Science and Engineering and Eve a Enns, MS, Department of Electrical Engineering, and Douglas Owens, MD, MS, and Alan Garber, MD , PhD, at the VA-Palo Alto and the Center for Health Policy.
Smith-Spangler was supported by a special fellowship in VA Health Services Research. Additional support came from the management at Stanford University Science and Engineering Advisory Board Scholarship Fund National Defense Science and Engineering Graduate Fellowship, National Science Foundation Graduate Fellowship and the Department of Veterans Affairs.
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