Table 1 Interventions targeting sodium consumption

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