Research Letters

Less salt does not necessarily mean less taste

The purpose of this article is to review the current situation with regard to sodium intake in the European Union, provide an update on the efforts being made to reduce the sodium content of food products in various industries via food reformulation and identify the factors motivating food reformulation.

A review was conducted of published literature as well as government and nongovernment organization websites and publications.

Food reformulation efforts have been made in the bread, meat, dairy and convenience foods industries. The World Health Organization (WHO) recommendation of < 5 g/day of dietary salt intake (< 2 g/day sodium) provides an internationally accepted baseline for reformulation efforts. Most Europeans continue to consume salt above the recommended limit. About half of the EU member states have legislated change in the form of taxation, mandatory nutrition labeling and regulated nutrition/health claims.

These actions have encouraged sodium reductions in existing food products, but food safety, consumer acceptance, cost and complications arising from the use of sodium alternatives remain limitations to food reformulation.

Bread is a major contributor to sodium intake in many countries. Reducing the salt (NaCl) content in bread might be an effective way to reduce overall sodium intake. The objectives of this study were to examine the effects of gradually lowering the salt content in brown bread, with and without flavor compensation (KCl and yeast extract), on bread consumption and sodium intake compensation by choice of sandwich fillings. A total of 116 participants (age: 21 ± 3 y; BMI: 22 ± 2 kg/m²) consumed a buffet-style breakfast on weekdays for 4 wk. Participants received either regular bread (control group: n = 39), bread whose salt content was gradually lowered each week by 0, 31, 52, and 67% (reduced group: n = 38), or bread whose salt content was also gradually lowered each week but which was also flavor compensated (compensated group: n = 39). A reduction of up to 52% of salt in bread did not lead to lower consumption of bread compared to the control (P = 0.57), whereas less bread was consumed when salt was reduced by 67% (P = 0.006). When bread was flavor compensated, however, a reduction of 67% did not lead to lower consumption (P = 0.69). Salt reduction in bread (with and without flavor compensation) did not induce sodium intake compensation (P = 0.31). In conclusion, a salt reduction of up to 52% in bread or even up to 67% in flavor-compensated bread neither affected bread consumption nor choice of sandwich fillings.

Background: Processed foods are major contributors to population dietary salt intake. Parts of the Australian food industry have started to decrease salt in a number of products. A definitive baseline assessment of current sodium concentrations in foods is key to targeting reformulation strategies and monitoring progress.

Objectives: Our objectives were to systematically collate data on the sodium content of Australian processed food products and compare sodium values against maximum target levels established by the UK Food Standards Agency (UK FSA).

Design: Categories of processed foods that contribute the majority of salt to Australian diets were identified. Food-composition data were sought for all products in these categories, and the sodium content in mg/100 g (or mg/100 mL for liquids) was recorded for each. Mean sodium values were calculated for each grouping and compared with the UK FSA benchmarks.

Results: Sodium data were collected for 7221 products in 10 food groups, 33 food categories, and 90 food subcategories. The food groups that were highest in sodium were sauces and spreads (1283 mg/100 g) and processed meats (846 mg/100 g). Cereal and cereal products (206 mg/100 g) and fruit and vegetables (211 mg/100 g) were the lowest in sodium. Sixty-three percent of food categories had mean sodium concentrations above the UK FSA targets, and most had wide ranges between the most and least salty product.

Conclusions: Many products, particularly breads, processed meats, and sauces, have salt amounts above reasonable benchmarks. The variation in salt concentrations between comparable products suggests that reformulation is highly feasible for many foods.

High intakes of dietary salt have long been associated with high blood pressure and an increased risk of heart disease and stroke. It is important to determine the patterns of salt intake, both discretionary intake and consumption of high salt foods being consumed frequently by the various consumer groups. Acquiring this data will enable health educators to target advice at the relevant consumer groups. It can also be used to lobby government and food manufacturers in relation to understanding how to reduce the salt content of processed foods frequently consumed by particular groups of consumers. As a part of a review and investigation of current trends in salt consumption and related consumer attitudes, it is important to consider the factors that have led to high salt intakes. This chapter discusses these factors. Changing consumer lifestyle patterns has had a significant impact on dietary intake in recent years and especially in relation to salt consumption. Lifestyle changes are among a comprehensive range of factors, which influence food choice. The chapter highlights the key factors that influence food choice in relation to increasing salt consumption. Raising consumer awareness of associated health risks is one way of endeavoring to reduce dietary salt intake; however, this alone will not guarantee a reduction in salt consumption at population level. It is, therefore, essential that food industry takes responsibility for reducing the salt content of processed food products, especially convenience style products.

Cardiovascular disease accounts for much morbidity and mortality in developed countries and is becoming increasingly important in less developed regions. Systolic blood pressure above 115 mm Hg accounts for two-thirds of strokes and almost half of ischaemic heart disease cases, and cholesterol concentrations exceeding 3·8 mmol/L for 18% and 55%, respectively. We report estimates of the population health effects, and costs of selected interventions to reduce the risks associated with high cholesterol concentrations and blood pressure in areas of the world with differing epidemiological profiles.

Effect sizes were derived from systematic reviews or meta-analyses, and the effect on health outcomes projected over time for populations with differing age, sex, and epidemiological profiles. Incidence data from estimates of burden of disease were used in a four-state longitudinal population model to calculate disability-adjusted life years (DALYs) averted and patients treated. Costs were taken from previous publications, or estimated by local experts, in 14 regions.

Non-personal health interventions, including government action to stimulate a reduction in the salt content of processed foods, are cost-effective ways to limit cardiovascular disease and could avert over 21 million DALYs per year worldwide. Combination treatment for people whose risk of a cardiovascular event over the next 10 years is above 35% is also cost effective leading to substantial additional health benefits by averting an additional 63 million DALYs per year worldwide.

The combination of personal and non-personal health interventions evaluated here could lower the global incidence of cardiovascular events by as much as 50%.