Salt tax could cut heart disease in developing countries: Study

By Nathan Gray

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Salt tax could cut heart disease in developing countries: Study

Related tags Salt reduction Salt

Voluntary industry reductions in salt content, in addition to tobacco style taxes on products containing salt, could help to cut cardiovascular deaths by three in developing countries that represent more than half of the world’s population, suggest researchers.

The suggestions come from preliminary data from a study assessing the cost-effectiveness of two interventions - voluntary salt reduction by industry, and taxation on salt - in 19 developing countries.

Presenting the findings at the World Congress of Cardiology in Dubai, lead researcher Dr. Thomas Gaziano from Harvard School of Medicine said that use of the strategies could reduce the number of deaths from cardiovascular disease (CVD) each year by 2-3 per cent in these countries. Gaziano said that the preliminary data are the first findings from a new report from Harvard that will be published later this year.

"These results show that strategies to reduce sodium consumption, even by modest amounts, could lead to significant reductions in CVD mortality in developing countries and potentially save overall healthcare costs associated with these diseases,"​ said Gaziano.

"In developing countries, where the burden of CVD is highest, these simple steps could deliver a significant long-term impact and must be something that governments trying to manage rising healthcare costs should consider,"​ he added.

World Action on Salt and Health (WASH) campaign director Katharine Jenner, told FoodNavigator that although a voluntary salt reduction has been proven successful in countries such as the UK, where over 75% of the salt we eat is from processed foods, “this study shows that countries where salt is added in the cooking or at the table could benefit from a tax which would discourage people from using so much salt.”

Jenner added that the UK in particular was ‘fortunate’ to have had an “excellent salt reduction programme.”​  

“People in other countries, particularly the developing world, haven't been so fortunate and so aren't preventing these otherwise preventable deaths from strokes and heart attacks,”​ she warned.

Salt reductions

The required salt reduction levels were modeled on the UK Food Standards Agency (FSA) data. The agency set a series of targets for individual food products that have led to a net intake reduction, so far, of 9.5% overall in the country. Data also suggesting that a taxation increase of 40% on industry prices – similar to that levied on tobacco – could lead to a 6% reduction in consumption was also evaluated.

The analysis found that both strategies would be save money by reducing the number of people needing treatment for high blood pressure (hypertension) and CVD ‘events’ such as heart attacks and stroke.

Gaziano and his colleagues revealed that together, the two strategies could reduce the incidence of heart attacks by up to around 1.7% and 1.47% in China and India respectively, whilst reductions in stroke incidence were estimated to be 4.7% in China and 4% in India.

Sodium risk

Sodium is a vital nutrient and is necessary for the body to function. However the average daily salt consumption in the western world (between 10 and 12 grams) vastly exceeds maximum recommendations from WHO/FAO of 5 grams per day.

Such high intakes of dietary sodium have been linked to negative health impacts, including the development of hypertension, cardiovascular disease, certain cancers, and other health problems..

The benefits of a global salt reduction strategy were given blinding clarity by a meta-analysis published in The Lancet Chronic Diseases Series in 2007, which concluded that reducing salt intake around the world by 15 per cent could prevent almost nine million deaths between 2006 and 2015.

The topic remains controversial, however, with a prestigious Cochrane review​ concluding that salt reduction did not impact cardiovascular disease risk. However, this was subsequently slammed in a re-analysis of the same data in The Lancet​, with the authors of this paper stating that salt reduction does provide a significant reduction in cardiovascular events.

Industry action

The process of reducing salt levels in foods is an ongoing process within the industry, with many now acknowledging that high sodium levels in some foods is a major issue for the industry.

However, the reduction of salt in processed foods is a major challenge because in addition to salts role as a flavour enhancer, the food industry has historically added salt (sodium chloride) to foods to enhance shelf life, modify flavour, enhance functionality, and to control fermentation.

Experts in the area have previously noted a clear need for the food industry to identify technical routes to enable these functionalities to be modified whilst reducing the concentration of sodium salts and maintaining the consumer experience.

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Proposed tax on salt - unoriginal, irrelevant and hopelessly out of touch

Posted by Morton Satin,

The paper suggesting a tax on salt is nothing more than a repeat of several similar proposals made over the years that are irrelevant and hopelessly out of touch with the available scientific evidence. Proposals for government regulations, salt taxes and even salt 'cap and trade' schemes have all missed the key point - salt is essential for life and any reduction in our current levels of consumption will end up doing the majority of consumers far more harm than good.

This latest desk-bound pontification typifies academic naval gazing at its most absurd. Comparing an essential nutrient with tobacco or alcohol is ludicrous to start with. The mathematical models used are based on highly flawed population approach assumptions which totally ignore the actual evidence. The UK FSA has made great claims regarding salt reductions, but where are the figures showing how this has benefitted consumers’ health? The majority of peer-reviewed medical studies published in the last two years has cautioned against population-wide salt reduction (1,2,3,4,5,6,7), including the latest one demonstrating that anyone who tries to follow the 2010 Dietary Guidelines for salt will end up with a highly unbalanced and nutritionally inadequate diet (8). These peer-reviewed publications all state that if consumers reduce their salt consumption below current levels, they will experience increased morbidity and mortality by aggravating conditions ranging from diabetes to cardiovascular disease. This latest salt tax paper doesn't even make an attempt to refute the evidence - it simply pretends it doesn’t exist. It's called ostrich research - bury you head in the ground in hopes that no one else has read the medical literature. Following this advice, consumers may literally end up being taxed to death!"

1)Taylor RS, Ashton KE, Moxham T, Hooper L, Ebrahim S. Reduced Dietary Salt for the Prevention of Cardiovascular Disease: A Meta-Analysis of Randomized Controlled Trials [Cochrane Review]. Am J Hyperten. 2011;24(8):843-853.
2)Garg R., Williams GH, Hurwitz S, Brown NJ, Hopkins PN, Adler GK. Low-Salt Diet Increases Insulin Resistance in Healthy Subjects, Metabolism. 2010;60(7):965-68. Epub 2010 Oct 30.
3)Stolarz-Skrzypek K, Kuznwtsova T, Thijs L, et al. Fatal and nonfatal outcomes, incidence of hypertension, and BP changes in relation to urinary sodium excretion. JAMA. 2011;305:1777-1785.
4)Graudal NA, Hubeck-Graudal T, Jurgens G. Effects of low-sodium diet vs. high-sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride (Cochrane Review). Am J Hypertens 2011;25:1-15.
5)E.I. Ekinci, S. Clarke, M.C. Thomas, et al., Dietary Salt Intake and Mortality in Patients With Type 2 Diabetes, 34 Diabetes Care 703-09 (2011).
6)Thomas MC, Moran J, Forsblom C, Harjutsalo V, Thorn L, Ahola A, Wadon J, Tolonen N, Saraheimo M, Gordin D, Groop PH; for the FinnDiane Study Group, The Association between Dietary Sodium Intake, ESRD, and All- Cause Mortality in Patients With Type 1 Diabetes. Diabetes Care. 2011 Apr;34(4):861-866. Epub 2011 Feb 9.
7)O'Donnell MJ, Yusuf S, Mente A, Gao P, Mann JF, Teo K, McQueen M, Sleight P, Sharma AM, Dans A, Probstfield J, Schmieder RE. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA. 2011 Nov 23; 306(20):2229-38.
8)Maillot M, Drewnowski A. A Conflict between Nutritionally Adequate Diets and Meeting the 2010 Dietary Guidelines for Sodium. Am J Prev Med. 2012;42(2):174-179.

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How robust is the conclusion

Posted by Mythbuster,

If the FSA has reduced sodium intakes by 9.5% has this been reflected in the predicted blood pressure reduction. There should be a large drop in UK population blood pressure if the claims of a reall association are true. The Natiuonal survey data in the NDNS should provide some evidence.

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