NICE Public Health Guidance: Prevention of Cardiovascular Disease
Extracted from: Recommendations for policy: a national framework for action
Recommendation 1: Salt
Over recent years the food industry, working with the Food Standards Agency, has made considerable progress in reducing salt in everyday foods. As a result, products with no added salt are now increasingly available. However, it is taking too long to reduce average salt intake among the population. Furthermore, average intake among children is above the recommended level – and some children consume as much salt as adults. Progress towards a low-salt diet needs to be accelerated as a matter of urgency.
Reduce population-level consumption of salt. To achieve this, the evidence suggests that the following are among the measures that should be considered.
What action should be taken?
- Accelerate the reduction in salt intake among the population. Aim for a maximum intake of 6 g per day per adult by 2015 and 3 g by 2025.
- Ensure children’s salt intake does not exceed age-appropriate guidelines (these guidelines should be based on up-to-date assessments of the available scientific evidence).
- Promote the benefits of a reduction in the population’s salt intake to the European Union (EU). Introduce national legislation if necessary
- Ensure national policy on salt in England is not weakened by less effective action in other parts of the EU.
- Ensure food producers and caterers continue to reduce the salt content of commonly consumed foods (including bread, meat products, cheese, soups and breakfast cereals). This can be achieved by progressively changing recipes, products and manufacturing and production methods.
- Establish the principle that children under 11 should consume substantially less salt than adults. (This is based on advice from the Scientific Advisory Committee on Nutrition.)
- Support the Food Standards Agency so that it can continue to promote – and take the lead on – the development of EU-wide salt targets for processed foods
- Establish an independent system for monitoring national salt levels in commonly consumed foods.
- Ensure low-salt products are sold more cheaply than their higher salt equivalents.
- Clearly label products which are naturally high in salt and cannot meaningfully be reformulated. Use the Food Standards Agency-approved traffic light system. The labels should also state that these products should only be consumed occasionally
- Discourage the use of potassium and other substitutes to replace salt. The aim of avoiding potassium substitution is twofold: to help consumers’ readjust their perception of ‘saltiness’ and to avoid additives which may have other effects on health.
- Promote best practice in relation to the reduction of salt consumption, as exemplified in these recommendations, to the wider EU.
Extracted from: Population-level approaches: cost effectiveness
The financial modelling for this guidance shows that considerable cost savings could be made. Using a number of conservative assumptions, it found that halving CVD events across England and Wales (a population of 50 million) would result in discounted savings in healthcare costs of approximately £14 billion per year. Reducing mean population cholesterol or blood pressure levels by 5% would result in discounted annual savings of approximately £0.7 billion and £0.9 billion respectively. Reducing population cardiovascular risk by even 1% would generate discounted savings of approximately £260 million per year.
A 3 g reduction in mean daily salt intake by adults (to achieve a target of 6 g daily) would lead to around 14–20,000 fewer deaths from CVD annually (Strazzullo et al. 2009). Using conservative assumptions, this means approximately £350 million in healthcare costs would be saved. In addition, approximately 130,000 quality-adjusted life years (QALYs) would be gained. A mean reduction of 6 g per day would double the benefits: an annual saving of £700 million in healthcare costs and a gain of around 260,000 QALYs. A 3 g reduction in daily salt intake (a reasonably conservative estimate of what could be achieved) would reduce systolic blood pressure by approximately 2 mmHg. This would equate to a 2% decrease in the risk reduction model. Similarly, a reduction of IPTFA intake to approximately 0.7% of total fat energy might save approximately 571,000 life years – and some £2 billion.