Reducing the sodium content of high-salt foods: effect on cardiovascular disease in South Africa.

BACKGROUND Average salt intake in South African (SA) adults, 8.1 g/day, is higher than the recommended 4 - 6 g/day recommended by the World Health Organization. Much salt consumption arises from non-discretionary intake (the highest proportion from bread, with contributions from margarine, soup mixes and gravies). This contributes to an increasing burden of hypertension and cardiovascular disease (CVD). OBJECTIVES To provide SA-specific information on the number of fatal (stroke, ischaemic heart disease and hypertensive heart disease) and non-fatal CVD events that would be prevented each year following a reduction in the sodium content of bread, soup mix, seasoning and margarine. METHODS Based on the potential sodium reduction in selected products, we calculated the expected change in population-level systolic blood pressure (SBP) and mortality due to CVD and stroke. RESULTS Proposed reductions would decrease the average salt intake by 0.85 g/person/day. This would result in 7 400 fewer CVD deaths and 4 300 less non-fatal strokes per year compared with 2008. Cost savings of up to R300 million would also occur. CONCLUSIONS Population-wide strategies have great potential to achieve public health gains as they do not rely on individual behaviour or a well-functioning health system. This is the first study to show the potential effect of a salt reduction policy on health in SA.