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Table 1 Interventions targeting sodium consumption

From: Correction to: The impact of food reformulation on nutrient intakes and health, a systematic review of modelling studies

Author (year) Study Characteristics Study Outcomes
Model type Time horizon Target foods Type of intervention(s) Voluntary or mandatory Reduction in intake Reduction in blood pressure (BP) Life years gained and reduction in the incidence of health outcomes Results on QOL measures
Cogswell et al. (2017) [29] Mathematical/Statistical Not modelled All processed food ↓28% in Na content (Health Canada Benchmarks) Mandatory 0.61 Na g/day (22%, UI = 0.59–0.63)
Choi et al. (2016) [30] Micro-simulation 10y All processed foods Product reformulated to meet product-specific NSRI criteria extended to all food producers in the US Mandatory 0.365 (SE = 0.9) Na g/day (10.9%) Hypertension: 0.97%
All AMI: 2.59%
All strokes: 2.67%
Fatal AMI: 0.36%
Fatal Strokes: 0.23%
Food and Drink Industry Ireland (2016) [26] Mathematical/Statistical Not modelled 10 Food macrocategories Reformulation based on actual FDII voluntary programme Mandatory extension of existing programme 0.57 Na g/day (17.8%) in adults
Voluntary 0.06 Na g/day (2.3%) in adults
Leroy et al. (2016) [32] Epidemiological 1y F&V, bread, meat, fish, sandwiches, sauces Strong reformulation based on the Choices Programme criteria Mandatory 12.7% daily Na intake Fatal CVD/Strokes deaths averted: 422
Cance deaths averted: 187
Mild reformulation based on the Choices Programme criteria Mandatory 9.3% daily Na intake CVD/Strokes and Cancer deaths averted: 2408 (3.7%) - due to total reductions in Na, SFA and sugar consumption combined
Masset et al. (2016) [25] Mathematical/Statistical Not modelled Pizza Reformulation to meet Nestlè Nutrient Profiling targets Mandatory 0.14 Na g/day (4%)
Nghiem et al. (2016) [42] Markov Cohort life-time All processed foods 59% substitution of NaCl with other salts (K, Mg) Mandatory 1.82 Na g/day (51.5%) 12,783 QALYs gained/100000 pop. (UI = 10,348–15,609)
25% substitution of NaCl with other salts (K, Mg) Mandatory 0.77 Na g/day (21.8%) 5261 QALYs gained/100000 pop. (UI = 4230–6391)
Bread ↓38,5% in NaCl content Mandatory 0.28 Na g/day (7.9%) 1891 QALYs gained/100000 pop. (UI = 1509–2296)
↓11,1% in NaCl content Mandatory 0.08 Na g/day (2.3%) 678 QALYs gained/100000 pop. (UI = 548–822)
Wilson et al. (2016) [43] Markov Cohort life-time All processed foods (bread, processed meats, sauces, snack food, bakery, cheese) ↓36% in NaCl content across product types Mandatory 0.628 Na g/day 5304 QALYs gained/100000 pop. (UI = 4270–6478)
Voluntary Same efficacy with higher uncertainty 5000 QALYs gained/100000 pop. (UI = 3709–6391)
Bread ↓12–37% in NaCl content across bread types Mandatory 0.043 Na g/day 387 QALYs gained/100000 pop. (UI = 309–470)
Voluntary Same efficacy with higher uncertainty 365 QALYs gained/100000 pop. (UI = 270–461)
Processed meats ↓35–55% in NaCl content overall Mandatory 0.069 Na g/day 583 QALYs gained/100000 pop. (UI = 470–704)
Voluntary Same efficacy with higher uncertainty 552 QALYs gained/100000 pop. (UI = 417–696)
Sauces ↓30–63% in NaCl content across sauces types Mandatory 0.104 Na g/day 870 QALYs gained/100000 pop. (UI = 700–1057)
Voluntary Same efficacy with higher uncertainty 822 QALYs gained/100000 pop. (UI = 626–1039)
Combination of bread, processed meats and sauces Mandatory 0.217 Na g/day 1843 QALYs gained/100000 pop. (UI = 1487–2239)
Voluntary Same efficacy with higher uncertainty 1743 QALYs gained/100000 pop. (UI = 1326–2204)
Snack food ↓34–48% in NaCl content across snacks types Mandatory 0.032 Na g/day 265 QALYs gained/100000 pop. (UI = 217–322)
Voluntary Same efficacy with higher uncertainty 252 QALYs gained/100000 pop. (UI = 191–317)
Bread and bakery products ↓12–37% in NaCl content across bread types; ↓54–63% in NaCl content across other bakery products Mandatory 0.107 Na g/day 887 QALYs gained/100000 pop. (UI = 722–1078)
Voluntary Same efficacy with higher uncertainty 843 QALYs gained/100000 pop. (UI = 639–1061)
Cheese ↓27–42% in NaCl content across cheese types Mandatory 0.045 Na g/day 383 QALYs gained/100000 pop. (UI = 309–461)
Voluntary Same efficacy with higher uncertainty 361 QALYs gained/100000 pop. (UI = 274–457)
Bruins et al. (2015) [45] Mathematical/Statistical Cohort life-time Soups ↓25% in Na content Mandatory 0.05 Na g/day 0.11 mmHg Strokes: 0.49% 6.45 DALYs averted/100000 pop
AMI: 0.34%
Angina: 0.34%
CHF: 0.24%
Dötsch-Klerk et al. (2015) [23] Mathematical/Statistical Not modelled All processed foods Products reformulated to meet the 6 g/day NaCl consumption target Mandatory US: 1.8 Na g/day (23%)
UK: 1.8 Na g/day (27%)
NL: 1.3 Na g/day (19%)
Products reformulated to meet the 5 g/day NaCl consumption target Mandatory US: 2.2 Na g/day (28%)
UK: 2.1 Na g/day (32%)
NL: 1.8 Na g/day (26%)
Gillespie et al. (2015) [31] Epidemiological 10y All processed foods ↓30% in NaCl Mandatory 0.58 Na g/day (UI = 0.56–0.60) 0.81 mmHg '(UI = 0.53–1.10) CHD deaths averted or postponed: 4467 (UI = 2854–6147)
↓10% in NaCl Mandatory 0.19 Na g/day (UI = 0.18–0.20) 0.27 mmHg (UI = 0.18–0.37) CHD deaths averted or postponed: 1502 (UI = 953–2068)
↓24% in NaCl Voluntary (applied to 39% of products) 0.19 Na g/day (UI = 0.03–0.63) 0.27 mmHg (UI = 0.04–0.92) CHD deaths averted or postponed: 1474 (UI = 220–4995)
Hendriksen et al. (2015) [22] Mathematical/Statistical Not modelled Selected foods contributing to high intakes of NaCl ↓50% in NaCl content on average Mandatory 0.9 Na g/day (37%)
Nghiem et al. (2015) [46] Markov Cohort life-time All processed foods ↓25% in NaCl Mandatory 0.525 Na g/day (15%) 4783 QALYs gained/100000 pop (UI = 3804–7174)
Breads, processed meats and sauces ↓25% in NaCl Mandatory 0.296 Na g/day (9%) 2683 QALYs gained/100000 pop (UI = 2161–3256)
Wilcox et al. (2015) [34] Epidemiological 10y Not modelled Not modelled Mandatory 0.005 Na g/day (10%) (UI = 0.003–0.021) 1.15 mmHg (UI = 0.57–4.58) CHD Deaths averted: 497 (UI = 130–3032)
LYG: 11192 (UI = 5679–41,039)
Collins et al. (2014) [36] Epidemiological 10y Not modelled ↓15% in NaCl content overall Voluntary 1.21 Na g/day (UI = 0.32–1.94) LYG: 14593(UI = 9000–21,049)
↓20% in NaCl content overall Mandatory 1.62 Na g/day (UI = 0.65–3.11) LYG: 19365(UI = 11,967–27,887)
Hendriksen et al. (2014) [47] Markov 20y (clinical outcomes); cohort life-time (DALYs) All processed foods ↓50% in NaCl content on average Mandatory 2.3 Na g/day (28%) 1.5 mmHg (1.2%) 4.4% AMI (UI = 3.1–5.6%) 0.5% DALYs averted in the population (UI = 0.37–0.68%)
CHF: 1.8% (UI = 1.3–2.3%)
Strokes: 6% (UI = 4.1–7.8%)
Increase in life expectancy: 0.7% (UI = 0.5–0.9%)
Mason et al. (2014) [53] Epidemiological 10y Not modelled Not modelled Mandatory 10% daily Na intake (UI = 5–40%) Tunisia: LYG 2272 (UI = 1151–3361)
Syria: LYG 11192 (UI = 5679–41,039)
Palestine: LYG 945 (UI = 479–3479)
Turkey: LYG 135221 (UI = 68,816–487,712)
Konfino et al. (2013) [37] Markov 10y All processed foods ↓8% in NaCl intake (stepped reduction by 4% for the first 2y) Mandatory (80% of sodium from processed foods) 0.353 Na g/day 1.00–2.00 mmHg Total Deaths: 0.61%
Fatal CHD: 0.98%
AMI: 1.48%
Strokes: 0.99%
↓40% in NaCl intake (4% per year for 10y) Mandatory (80% of sodium from processed foods) 1.763 Na g/day 5.00–9.00 mmHg Total Deaths: 1.77%
Fatal CHD: 2.63%
AMI: 4.27%
Strokes: 2.79%
Bertram et al. (2012) [38] Epidemiological 1y Bread, margarine, gravy, soups ↓54% in NaCl content on average Mandatory 0.85 Na g/day Strokes: 8%
CHD: 6.5%
Hypertensive heart disease: 11%
Cobiac et al. (2012) [48] Markov Cohort life-time Bread, margarine, breakfast cereals Based on Heart Foundation Tick Programme: ↓26% in NaCl content in bread; 11% in margarine and 61% in breakfast cereals Mandatory 0.009 Na g/day 1451 DALYs averted/100000 pop (UI = 1088–1813)
Combris et al. (2011) [8] Mathematical/Statistical Not modelled Breakfast cereals Mild to strong reformulation based on food nutrient distribution Mandatory 0.001–0.013 Na g/day (1.4–13.5%)
Biscuits/ pastries 0.0003–0.002 Na g/day (1.70–10.81%)
Bread-based products 0.0023–0.013 Na g/day (1.60–8.8%)
Cobiac et al. (2010) [49] Epidemiological Cohort life-time Bread, margarine, breakfast cereals Based on Heart Foundation Tick Programme: ↓26% in NaCl content in bread; 11% in margarine and 61% in breakfast cereals Voluntary 0.009 Na g/day 5300 DALYs averted (UI = 2600–9200)
Mandatory extension of actual program to all products 110,000 DALYs averted (UI = 53,000–180,000)
Smith-Spangler et al. (2010) [50] Markov Cohort life-time Not modelled Not modelled Voluntary 9.5% daily Na intake (UI = 5–40%) 1.25 mmHg Strokes averted: 513885 2,060,790 DALYs averted
AMI averted: 480538
Roodenburg et al. (2009) [27] Mathematical/Statistical Not modelled All processed foods Reformulation set to meet Choices Programme criteria Mandatory 23% daily Na intake (10% adjusting for energy compensation)
Rubinstein et al. (2009) [51] Markov Cohort life-time Bread ↓ to 1 g of NaCl per 100 g of bread Voluntary 1.33 mmHg 18.7 DALYs averted/100000 pop
Murray et al. (2003) [52] Markov Cohort life-time Not modelled Not modelled Mandatory Assumed 30% Na Intake AmrB: 3.11% on average 600,000 DALYs averted
EurA: 3.49% on average 1,300,000 DALYs averted
SearD: 3.49% on average 1,000,000 DALYs averted
Voluntary Assumed 15% Na Intake AmrB: 1.56% on average 300,000 DALYs averted in the population
EurA: 1.74% on average 700,000 DALYs averted in the population
SearD: 1.75% on average 500,000 DALYs averted in the population
  1. Abbreviations: AMI Acute Myocardial Infarction, AmrB Region of the Americas group B, CHD Coronary Heart Disease, CHF Coronary Heart Failure, CVD Cardiovascular diseases, DALY Disability Adjusted Life Years, EurA European Region group A, FDII Food and Drink Industry Ireland, F&V fruit and vegetables, K potassium, LYG Life Years Gained, Mg magnesium, Na sodium, NaCl Sodium Chloride, NL Netherlands, NSRI National Salt Reduction Initiative, QALY Quality Adjusted Life Year, SearD Southeast Asian Region group D, UI Uncertainty Interval, UK United Kingdom, US United States of America