CVD Prcvcntion and Conrrol (Z01Ui 4, 189*191

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N. Carnpbell., B. Legowski, B. Legetic, R,. Wi{ks,A.B. Pinto de Atmeida vasconcellos, 0n behatf of the pApfs/wplgR'egional Expert. Group on Cardiovascular Disease pr-everrticn throughDietary Satt Reduction. 1

Received 16 December 2009; accepted 16 December 2009Avai(abte online 8 Februarv 2010

Corresponding author. Tet.: +1 613737 9153,

, E-moil address: ncampbel@ucai.gary.ca (N. Campbett).' Norm Campbett, Chair (University of Catgary _ Canada);Rainford Wi{ks, Co-chair for the Caribbean {Tropical. MedicineResearch lnstitute - Jamaica); Ana Beatriz pinto de A,tmeidaVasconcetlos, Co-chair for Latin America (Ministry of Heatth- Brazit); 5im6n Barquera (Nationat lnstitute of pubtic Heal.th- Mexico); Adriana Btanco-Me?ler (lnstitute for Research andEducation in Nutrition and Health (|NCIENSA) - Costa Rica):Ezzedine Boutrif (FAO - ltaty); Francesco Cappuccio (WarwickUniversity * Engtand); Beatriz Champagne ilnterAmericanHeart Foundation * United States); Ricardo Correa-Rotter(Satvador Zubiran National Institute of Medicat Scrences ancNutrition (INNSZ) - Mexico); Omar Dary (MZ project _ UnitedStates); Darwin Labarthe {CDC - United States); Mary L,Abbe(University of Toronto * Canada); Hubert Linders (ConsumersInternational, Regionat Office for Latin America and theCaribbean - Chite); Carlos Monteiro (University of Sao paoto- Erazil.); Tito pizarro (Ministry of Heatth _ Chite); JorgePoL6nia (University of Fernado pessoa - portugat); MarceloTavetla (Program for the prevention of Infarct in .Argentina(PROPIA) - Argentira); Ricardo Uauy {lnstitute for Nutririonand Food Technology {INTA) - Chite); Lianne Vardy (pubiicl{eatth Agency of Canada).

Policy goal

A gradual and sustained drop in dietary satt intaketo reach national targets or the internationatiy rec_ommended target of less than 5 g/daylperson by7420.

Audience

Policy and decision makers in government, leadersin non-governmental organizations (representingconsumers, health, scientific and health care pro-fessionats), civil society, the food industry (inctud_ing food processors and distributors), among foodimporters and exporters, and in pAHO.

Rationale

e lncreased btood pressure wortd-wide is the [ead-ing risk factor for death and the second teadingrisk for disabitity by causing hearc disease,stroke and kidney fafture.

ELSEVIER

1875-4570/5 - see front matter o 2010 wortd Heart Federation. Pubtished by Etsevier Ltd. Att rights reserved.doiil 0. 1 01 6 / j. cv dpc.21A9 j 2.A03

1 9 0 N. Campbetl et at .

o In th€ Americas, between 1/5 and 1/3 of at tadutts has hypertension and once age 80 isreached, over 90% can be expected to behypertensive.

' ln 2001, the rnanagement of non-optimal bioodpressure i.e. systotic pressure over 115 mm Hgconsumed about 107o of the vrortd's overailheatthcare expenditu res.

o As dietary satt consumption increases, so doesbtood pressure. Typical modern diets provideexcessive arnounts of salt, from early chitdhoodthrough adulthood-

c The recommended intake of satt is less than 5 g/daylperson. In the Americas, intake can be overdouble the recommended tevet, Att age groupsincluding chitdren are affected.

r Adding satt at the tabte is not the onty probtem.In most poputations by far the largest amount ofdietary salt comes from ready-made meals andpre-prepared foods, inctuding bread, processedmeats, and even breakfast cereals.

o Reducing satt consumption poputation-wide isone of the most cost-effective measures avait-abte to pubtic heatth. lt can tower the rates ofa number of related chronic diseases and condi-tions at an estimated cost of between 50.04 and50.32 US per person per year. Popul.ation-wideinterventions can atso distribute the benefits ofheatthy btood pressure equitabty.

o Governments are justified in intervenfng directtyto reduce poputation-wide satt consumptionbecause salt additives in food are so common.Peopteare unawareof how much satttheyare eat-ing in different foods and of the adverse effects ontheir heatth- Chitdren are especiatty vulnerabte.

n Satt intake can be reduced without compromis-ing micronutrient fortification efforts.

Recommendations for policy and action

The recommendations betow are consistent with theWortd Heatth Organization's three pittars for success-ful. dietary satt reduction: product reformu[ation;consumer awareness and education campaigns; andenvironmentaI changes to make heatthy choices theeasiest and most affordabte options for atl peopte.

To national governments

o Seek endorsement of this poticy statement byministries of hea(th, agricutture and trade, byfood regutatory agencies, nationat pubticheatth leaders, non-governrnental organizations(NGOs), academia, and retevant foodindustries.

o Develop sustainabte, funded, scientifically basedsalt reduction programs that are integrated jntoexisting food, nutrition, heaith and educationprograrns. The programs shoutd be socia[{y inclu-sive and include major socioeconornic, racial,culturat, gender and age subgroups and specifi-caily children. Components shoutd inciude:

r Standardized food tabeting such that consum-ers can easity identify high and tow salt foods.

r Educating people inctuding chi(dren about theheatth risks of high dietary satt and how toreduce salt intake as part of a heatthy diet.

r lnitiate cottaboration with retevant domesticfood industries to set graduatty decreasing iar-gets, with timetines, for satt levets accortlingto food categories, by regutation or through eco-nomic incentives or disincentives with govern-ment oversight.

. Regutate or otherwise encourage domestic andmultinationa[ food enterprises to adopt thelowest of a) best in ctass (sa[t content tornatch the lowest in the specific food category)and b) best in wortd for the national rrarket(match the lowest salt content of the specificfood produced by the company etsewhere inthe wortd).

o Devetop a nationat surveittance system with reg-utar reporting to identify dietary satt intake tev-ets and the major sources of dietary satt.Monitor progress towards the nationat target{s)" for dietary satt intake or the internationail,y rec-ommended target.

" Review national satt fortification poticies andrecommendations to be in concordance withthe recornrnended salt intake.

r Extend official support to the Codex Aiimentari-us committee on food labeling for salt/sodiumto be inctuded as a mandatory component ofnutrition tabels.

e Develop legistative or regutatory frameworks toimptement the Wortd Heatth Organization(WHO) recommendations on advertjsing of foodproducts and beverages to chitdren.

To non-governmental organizations, healthcare organizations, associations of heatthprofessionals

a Endorse this poticy statement.r Educate memberships on the heatth risks of high

dietary satt and how to reduce satt intake.Encourage invotvement in advocacv. Monitor

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and promote presentations on dietary satt atnationaI meetings and the pubtication of articteson dietary salt.

o Promote and advocate rnedia releases on die-iary salt reduction to reach the pubtic, inctud-ing chitdren and particularty $/omen giventheir integrat rotes in famity heatth and foodpreparation.

" Broadty disseminate retevant literature.s Educate poticy and decision makers on the

heatth benefits of lowering btood pressureamong normotensive and hypertensive people,regardtess of age.

e Advocate poticfes and regutations that wiit con-tribute to poputation-wide reductjons in dietarysatt.

* Promote coatition building, increase organiza-tional capacity for advocacy and devetop advo-cacy toots to promote civil scciety actions.

To the food industry

r Endorse this poticy statement.' Make current best in ctass and best in wortd [ow

satt products and practices universat acrossgl.obat markets as soon as possibte. Make satt sub-stitutes readity availabte at affordabte prices.

c Institute reformu(ation schedutes for a gradualand sustained reduction in the salt content ofa[[ existing satt-containing food products, res-taurant and ready-made meats to contribute toachieving the internationalty recommended tar-get or nationat targets where applicabte. Makeatt new food product formutations inherenttv[ow in sal t .

r Use standardized, ctear and easy-to-understandfood labets that inctude information on sattc0ntent.

r Promote the heatth benefits of low satt diets toatl peoptes of the Americas.

To the Pan Annerican Heelth Srganization

" fnsure good communications and informatronsharing between regional and international ini-tiatives to foster best practices.

e Develop a temptate for national report cards andreport to Member States on comparativenationat basetines and progress at pre specifiedtime points (e.g. in 2010 the basetine, progressin 2015 and 2020).

e Work with Member States to monitor dietary sattconsumption in the Americas.

c Devetop and foster a network of endorsing gov-ernments, NGOs, and expert champions on die-tary satt in the Pan American region.

' Develop a web based .toolbox' with educationalmaterials and programs on dietary satt for thepublic, patients, heatth care professionals thatare cutturatty appropriate to sub-regions of theAmericas.

" Develop and advocate conflict of interest gr:.icie-lines to assist heatth organizations and scientistsin the Pan American region in their interactionswith the food industry.

o Foster research on the economic and heatthimpacts of high dietary satt in the couniriesand sub-regions of the pan American resion.

o Assist Member States to revise national ind sub-regional fortification prograrns to be consistentwith efforts to reduce dietary satt.

o Cottaborate with the Food and Agricutture Orga-nization (FAO), UNICEF, the Ccdex AtimentariusCommission and other retevant UN bodies toachieve a consistent and coordinated approachto reducing dietary satt.

r Educate poticy and decision makers on thehealth benefits of lowering btood pressureamong normotensive and hypertensive people,regardless of age.

o Advocate policies and regutations that witt con-tribute to poputation-wide reductions in dietarvsatt.

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