Wilson Nick, Nghiem Nhung, Eyles Helen, Mhurchu Cliona Ni, Shields Emma, Cobiac Linda J, Cleghorn Christine L, Blakely Tony
Department of Public Health (BODE3 Programme), Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, University of Otago, PO Box 7343, Wellington, Wellington South, New Zealand.
National Institute for Health Innovation and Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
Nutr J. 2016 Apr 26;15:44. doi: 10.1186/s12937-016-0161-1.
Dietary salt reduction is included in the top five priority actions for non-communicable disease control internationally. We therefore aimed to identify health gain and cost impacts of achieving a national target for sodium reduction, along with component targets in different food groups.
We used an established dietary sodium intervention model to study 10 interventions to achieve sodium reduction targets. The 2011 New Zealand (NZ) adult population (2.3 million aged 35+ years) was simulated over the remainder of their lifetime in a Markov model with a 3 % discount rate.
Achieving an overall 35 % reduction in dietary salt intake via implementation of mandatory maximum levels of sodium in packaged foods along with reduced sodium from fast foods/restaurant food and discretionary intake (the "full target"), was estimated to gain 235,000 QALYs over the lifetime of the cohort (95 % uncertainty interval [UI]: 176,000 to 298,000). For specific target components the range was from 122,000 QALYs gained (for the packaged foods target) down to the snack foods target (6100 QALYs; and representing a 34-48 % sodium reduction in such products). All ten target interventions studied were cost-saving, with the greatest costs saved for the mandatory "full target" at NZ$1260 million (US$820 million). There were relatively greater health gains per adult for men and for Māori (indigenous population).
This work provides modeling-level evidence that achieving dietary sodium reduction targets (including specific food category targets) could generate large health gains and cost savings for a national health sector. Demographic groups with the highest cardiovascular disease rates stand to gain most, assisting in reducing health inequalities between sex and ethnic groups.
减少膳食盐摄入是国际上非传染性疾病控制的五大优先行动之一。因此,我们旨在确定实现全国钠减排目标以及不同食物组的分项目标对健康的益处和成本影响。
我们使用一个既定的膳食钠干预模型来研究实现钠减排目标的10种干预措施。在一个马尔可夫模型中,以3%的贴现率模拟了2011年新西兰成年人口(230万35岁及以上)的余生。
通过实施包装食品中钠的强制性最高限量,以及减少快餐/餐厅食品中的钠和随意摄入量(“全面目标”),使膳食盐摄入量总体降低35%,估计在该队列的一生中可获得23.5万个质量调整生命年(95%不确定区间[UI]:17.6万至29.8万)。对于特定目标成分,范围从包装食品目标获得的12.2万个质量调整生命年到休闲食品目标(6100个质量调整生命年;代表此类产品钠减少34 - 48%)。所研究的所有十种目标干预措施都节省了成本,强制性“全面目标”节省的成本最大,为12.6亿新西兰元(8.2亿美元)。男性和毛利人(原住民)每成年人获得的健康收益相对更大。
这项工作提供了模型层面的证据,表明实现膳食钠减排目标(包括特定食物类别目标)可为国家卫生部门带来巨大的健康收益和成本节约。心血管疾病发病率最高的人群受益最大,有助于减少性别和种族群体之间的健康不平等。