Government mandates to moderate the limit of salt in processed foods could be 20 times more effective than offering the food industry incentives to voluntarily reduce sodium in its products, findings published this week in Heart show.

Health agencies in many countries, including the United States, now recommend restricting daily sodium intake to approximately 6g of table salt or less to prevent hypertension and cardiovascular disease; however, few countries meet this goal

“Leaving it to individuals to make their own choices about dietary behavior (even with intensive advice) leads to limited health benefits,” wrote Linda J. Cobiac, MD, and colleagues from the School of Population Health at the University of Queensland in Herston, Australia.

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They compared cost savings and health outcomes associated with government legislation and two other protocols for reducing dietary salt content: the Tick program, a national health incentive program that provided food manufacturers with an endorsed logo to promote sales after voluntarily cutting back the amount of salt in their food, and physician guidance for those at increased (systolic BP >115 mm Hg) and high risk (systolic BP >140 mm Hg) for cardiovascular disease.

The researchers devised several modeling schemes that took the salt content of bread, margarine and cereals into consideration; the tonnage of product sold; average consumption per head of these products; the cost of drafting and enforcing legislation; and systematic evidence reviews for the impact of dietary advice from healthcare professionals.

If everyone reduced salt intake to recommended limits, the researchers projected that a total of 610,000 disability-adjusted life years could be averted over the lifetime of the population. Simply offering dietary advice to at-risk populations would have the least impact, averting less than 0.5% of cardiovascular disease burden and is not cost effective, they determined.

Results from voluntary industry sodium restrictions imposed under the current Tick incentive scheme were better, indicating cost savings and an almost 1% reduction in population-wide cardiovascular disease risk. However, the researchers found that these health benefits would increase substantially if Tick incentives were enforced by a government mandate, reducing cardiovascular disease burden by as much as 18%.

“For the prevention of cardiovascular disease, providing dietary advice to everyone with elevated BP (or even just those at highest risk) will not achieve large improvements in population health and is not a cost-effective strategy for health sector investment,” the researchers wrote.

They support a government mandate to gradually reduce the sodium content in processed and prepared foods if manufacturers fail to respond to current health recommendations.

“Salt is added to processed foods for many reasons; to entice further consumption, to bulk a product up cheaply by increasing water-holding capacity, or to promote drink sales by increasing thirst,” the researchers wrote. “Food manufactures have a responsibility to make money for their shareholders, but they also have a responsibility to society.”

Concurrent with these recommendations, a recent report from the U.S. Institute of Medicine advocated instituting mandatory national standards as the primary method for reducing sodium intake, recommending voluntary strategies only as an interim solution.