Changes in the Sodium Content of Foods Sold in Four Latin American Countries: 2015 to 2018.

In 2015, the Pan American Health Organization (PAHO) published sodium targets for packaged foods, which included two distinct levels: one "regional" and one "lower" target. Changes to the sodium content of the food supply in Latin American Countries (LAC) has not been evaluated. A repeated cross-sectional study used food label data from 2015 (n = 3859) and 2018 (n = 5312) to determine changes in the proportion of packaged foods meeting the PAHO sodium targets and the distribution in the sodium content of foods in four LAC (Argentina, Costa Rica, Paraguay, Peru). Foods were classified into the 18 food categories in the PAHO targets. The proportion of foods meeting the regional targets increased from 82.9% to 89.3% between 2015 and 2018 (p < 0.001). Overall, 44.4% of categories had significant decreases in mean sodium content. Categories with a higher proportion of foods meeting the regional and lower targets in 2018 compared to 2015 (p < 0.05) were breaded meat and poultry, wet and dry soups, snacks, cakes, bread products, flavored cookies and crackers, and dry pasta and noodles. While positive progress has been made in reducing the sodium content of foods in LAC, sodium intakes in the region remain high. More stringent targets are required to support sodium reduction in LAC.

Baseline and Estimated Trends of Sodium Availability and Food Sources in the Costa Rican Population during 2004-2005 and 2012-2013.

In 2012, Costa Rica launched a program to reduce salt and sodium consumption to prevent cardiovascular disease and associated risk factors, but little was known about the level of sodium consumption or its sources. Our aim was to estimate the magnitude and time trends of sodium consumption (based on food and beverage acquisitions) in Costa Rica. Data from the National Household Income and Expenditure Surveys carried out in 2004-2005 (n = 4231) and 2012-2013 (n = 5705) were used. Records of food purchases for household consumption were converted into sodium and energy using food composition tables. Mean sodium availability (per person/per day and adjusted for a 2000-kcal energy intake) and the contribution of food groups to this availability were estimated for each year. Sodium availability increased in the period from 3.9 to 4.6 g/person/day (p < 0.001). The income level was inversely related to sodium availability. The main sources of sodium in the diet were domestic salt (60%) in addition to processed foods and condiments (with added sodium) (27.4%). Dietary sources of sodium varied within surveys (p < 0.05). Sodium available for consumption in Costa Rican households largely exceeds the World Health Organization-recommended intake levels (<2 g sodium/person/day). These results are essential for the design and implementation of effective policies and interventions.

Sodium Reduction in Processed Foods in Brazil: Analysis of Food Categories and Voluntary Targets from 2011 to 2017.

Non-communicable diseases, including cardiovascular diseases, are responsible for over 70% of deaths in Brazil. Currently, over 25% of Brazilian adults are diagnosed as hypertensive; overall, current dietary sodium intake in Brazil (4700 mg/person) is over twice the international recommendations, and 70-90% of adolescents and adults consume excessive sodium. National sodium reduction strategies consider the main dietary sources of sodium to be added salt to foods, foods consumed outside of the household, and sodium in processed foods. The national voluntary strategy for sodium reduction in priority food categories has been continuously monitored over a 6-year period (2011-2017) and there was a significant 8-34% reduction in the average sodium content of over half food categories. Different food categories have undergone differing reductions in sodium over time, aiding gradual biannual targets to allow industries to develop new technologies and consumers to adapt to foods with less salt. By 2017, most products of all food categories had met the regional targets proposed by the Pan American Health Organization, showing that voluntary sodium reduction strategies can potentially contribute to food reformulation. Nevertheless, regulatory approaches may still be necessary in the future in order to reach all food producers and to allow stronger enforcement to meet more stringent regional targets.

The impact of voluntary targets on the sodium content of processed foods in Brazil, 2011-2013.

Brazilians consume excessive dietary sodium (4700 mg/d); hence, the reduction of dietary sodium intake has been a Brazilian government priority. A set of strategies has been implemented that includes food and nutrition education initiatives and the reduction in the sodium content of processed foods and foods consumed out of the households. Since 2011, the Ministry of Health has selected priority food categories that contribute to over 90% of sodium intake from processed foods and have set biannual voluntary targets for sodium reduction with food industries to encourage food reformulation. Three rounds of monitoring of the sodium content on food labels have been conducted for instant pasta, commercially produced breads, cakes and cake mixes, cookies and crackers, snacks, chips, mayonnaise, salt-based condiments, and margarine. Between 90% and 100% of the food products achieved the first targets in the 2011-2013 period, and the average sodium content of food categories was reduced from 5% to 21% in these first 2 years. These data show that with close monitoring and government oversight, voluntary targets to reduce the sodium content in processed foods can have a significant impact even in a short time frame. The Brazilian strategy will be continuously monitored to maximize its impact, and, if necessary in the future, a transition to regulatory approaches with stronger enforcement may be considered.

Inaugural Maximum Values for Sodium in Processed Food Products in the Americas.

Reducing dietary salt/sodium is one of the most cost-effective interventions to improve population health. There are five initiatives in the Americas that independently developed targets for reformulating foods to reduce salt/sodium content. Applying selection criteria, recommended by the Pan American Health Organization (PAHO)/World Health Organization (WHO) Technical Advisory Group on Dietary Salt/Sodium Reduction, a consortium of governments, civil society, and food companies (the Salt Smart Consortium) agreed to an inaugural set of regional maximum targets (upper limits) for salt/sodium levels for 11 food categories, to be achieved by December 2016. Ultimately, to substantively reduce dietary salt across whole populations, targets will be needed for the majority of processed and pre-prepared foods. Cardiovascular and hypertension organizations are encouraged to utilize the regional targets in advocacy and in monitoring and evaluation of progress by the food industry.

International collaborative project to compare and monitor the nutritional composition of processed foods.

BACKGROUND: Chronic diseases are the leading cause of premature death and disability in the world with overnutrition a primary cause of diet-related ill health. Excess energy intake, saturated fat, sugar, and salt derived from processed foods are a major cause of disease burden. Our objective is to compare the nutritional composition of processed foods between countries, between food companies, and over time. DESIGN: Surveys of processed foods will be done in each participating country using a standardized methodology. Information on the nutrient composition for each product will be sought either through direct chemical analysis, from the product label, or from the manufacturer. Foods will be categorized into 14 groups and 45 categories for the primary analyses which will compare mean levels of nutrients at baseline and over time. Initial commitments to collaboration have been obtained from 21 countries. CONCLUSIONS: This collaborative approach to the collation and sharing of data will enable objective and transparent tracking of processed food composition around the world. The information collected will support government and food industry efforts to improve the nutrient composition of processed foods around the world.