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Study highlights the benefits of a US salt reduction strategy to US food industry

July 24, 2019

New research, published in The Milbank Quarterly, highlights the potential health and economic impact of the United States (US) Food and Drug Administration's (FDA) proposed voluntary salt policy on workers in the US food industry.

Excess salt consumption is associated with higher risk of cardiovascular disease (CVD). Globally, more than 1.5 million CVD related deaths every year can be attributed to excess dietary salt intake.

The World Health Organization has recommended sodium reduction as a "best buy" to prevent cardiovascular disease (CVD). In 2016, the US Food and Drug Administration (FDA) set voluntary targets for food industry to reduce sodium in processed foods.

In a previous study, researchers from the University of Liverpool, Imperial College London, Friedman School of Nutrition Science and Policy at Tufts and collaborators as part of the Food-PRICE project, found that for the whole US population the optimal reformulation scenario, 100% compliance with the 10-year FDA targets, could prevent approximately 450,000 CVD cases, gain 2 million Quality Adjusted Life Years (QALYs) and produce discounted cost savings of approximately $40 billion over a 20 year period.

Despite this, Congress has temporarily blocked the FDA from implementing voluntary industry targets for sodium reduction in processed foods, the implementation of which could cost the industry around $16 billion over 10 years.

This new study examined the impact of the policy on the food industry itself to determine the cost effectiveness of meeting these draft sodium targets.

The team modelled the health and economic impact of meeting the two-year and 10-year FDA targets, from the perspective of people working in the food system itself, over 20 years, from 2017 to 2036.

They found that the benefits of implementing the FDA voluntary sodium targets extend to food companies and food system workers, and the value of CVD-related health gains and cost savings are together greater than the government and industry costs of reformulation.

The researchers found that achieving long-term sodium reduction targets could produce 20-year health gains of approximately 180,000 QALYs and produce health cost savings of approximately $5.2 billion.

Because many health benefits may occur in individuals over age 65 years or the uninsured, these health savings would be shared among individuals, industry, and government.

Brendan Collins, Public Health Economist (who co-led the study with Dr Chris Kypridemos), University of Liverpool, said: "Excess dietary salt kills people. Salt reduction has therefore been recommended by the World Health Organisation as a "best buy". Around three quarters of salt is hidden in packaged foods before we buy them. That makes it very hard for people to cut their intake."

"We have shown that reducing the salt hidden in processed foods would have huge economic benefits because fewer people get high blood pressure which leads to strokes and heart attacks. That remains true even when just looking at people working in the food industry itself, because they cost their company less in healthcare, and they can continue working and looking after their families for longer."

Professor Simon Capewell, co-author, University of Liverpool, said: "The message for our own UK Government is also clear. A laissez faire approach will kill or maim thousands of people. We therefore welcome the new Prevention Green Paper focus on salt. Reactivating the previously successful FSA approach would prevent thousands of deaths, and powerfully assist the NHS, UK employers and the UK economy".
The full study, entitled 'FDA Sodium Reduction Targets and the Food Industry: Are There Incentives to Reformulate? Microsimulation Cost-Effectiveness Analysis', can be found at

University of Liverpool

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