Background Salt consumption is a major risk factor for high blood pressure and thus cardiovascular diseases (CVD), yet most countries in the world consume excessive salt. In Brazil, salt reduction policies currently include only voluntary sodium targets and communication strategies. This study aims to quantify the potential health and economic impact of additional salt reduction strategies in Brazil from 2019 to 2038.
Methods We used a previously validated microsimulation approach of a close-to-reality synthetic population (IMPACT NCD BR Model) to estimate CVD cases and deaths prevented or postponed by reducing sodium intake and disease treatment cost savings from 2019 to 2038. We quantified uncertainities as 95% Uncertainty Intervals (95% UIs).
We compared 1) regulatory front of pack labelling warnings for excessive salt content in foods
2) universal use of 10% potassium table salt, and 3) regulatory targets for maximum salt content in packaged foods to equal the lowest sodium targets achieved in other countries, considering the impact of sodium reduction and, for scenario 2, additionally increased dietary potassium.
To inform model inputs, we used the data from national surveys, public health information systems and high-quality meta-analyses. Cost estimates in international dollars (Int$) are based on a societal perspective and do not include the costs of policy implementation.
Results Our preliminary estimates suggest that between 2019 and 2038, mandatory front of pack labelling warnings could prevent or postpone approximately 400,000 CVD case-years (95% UI: 130,000 to 870,000) and some 7,000 CVD deaths (1,000 to 18,000). The replacement of regular table salt for 10% potassium salt could prevent or postpone approximately 780,000 CVD case-years (290,000 to 1,660,000) and 55,000 CVD deaths (34,000 to 87,000), while regulatory targets could prevent or postpone approximately 850,000 CVD case-years (270,000 to 1,800,000) and some 15,000 CVD deaths (4,000 to 33,000).
The total cost savings related to CVD treatment could reach approximately Int$ 1.1 billion (Int$ 360m to 2,450m), Int$ 1.7 billion (Int$ 770m to 4,490m) and Int$ 2.4 billion (Int$ 760m to 4,850m), for the mandatory front of pack warnings, 10% potassium table salt, and regulatory targets respectively.
Conclusion The current Brazilian voluntary salt targets may produce modest health and economic impacts. However, our analysis suggests that stricter regulatory targets for the food industry, mandatory front of pack warning labels and universal use of low sodium table salt could maximise the health and economic benefits of salt reduction for the Brazilian people.
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