Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
Center for Epidemiological Research on Health and Nutrition, University of São Paulo, São Paulo, State of São Paulo, Brazil.
PLoS One. 2023 May 10;18(5):e0284733. doi: 10.1371/journal.pone.0284733. eCollection 2023.
Cardiovascular diseases (CVDs) are the second leading cause of total deaths in Canada. High blood pressure is the main metabolic risk factor for developing CVDs. It has been well established that excess consumption of sodium adversely affects blood pressure. Canadians' mean sodium intakes are well above recommended levels. Reducing dietary sodium intake through food reformulation has been identified as a cost-effective intervention, however, dietary sodium intake and the potential health impact of meeting recommended sodium intake levels due to food reformulation have not been determined in Canada.
This study aimed to 1) obtain robust estimates of Canadians' usual sodium intakes, 2) model sodium intakes had foods been reformulated to align with Health Canada's sodium reduction targets, and 3) estimate the number of CVD deaths that could be averted or delayed if Canadian adults were to reduce their mean sodium intake to recommended levels under three scenarios: A) 2,300 mg/d-driven by a reduction of sodium levels in packaged foods to meet Health Canada targets (reformulation); B) 2,000 mg/d to meet the World Health Organization (WHO) recommendation; and C) 1,500 mg/d to meet the Adequate Intake recommendation.
Foods in the University of Toronto's Food Label Information Program 2017, a Canadian branded food composition database, were linked to nationally representative food intake data from the 2015 Canadian Community Health Survey-Nutrition to estimate sodium intakes (and intakes had Health Canada's reformulation strategy been fully implemented). The Preventable Risk Integrated ModEl (PRIME) was used to estimate potential health impact.
Overall, mean sodium intake was 2758 mg/day, varying by age and sex group. Based on 'reformulation' scenario A, mean sodium intakes were reduced by 459 mg/day, to 2299 mg/day. Reducing Canadians' sodium intake to recommended levels under scenarios A, B and C could have averted or delayed 2,176 (95% UI 869-3,687), 3,252 (95% UI 1,380-5,321), and 5,296 (95% UI 2,190-8,311) deaths due to CVDs, respectively, mainly from ischaemic heart disease, stroke, and hypertensive disease. This represents 3.7%, 5.6%, and 9.1%, respectively, of the total number of CVDs deaths observed in Canada in 2019.
Results suggest that reducing sodium intake to recommended levels could prevent or postpone a substantial number of CVD deaths in Canada. Reduced sodium intakes could be achieved through reformulation of the Canadian food supply. However, it will require higher compliance from the food industry to achieve Health Canada's voluntary benchmark sodium reduction targets.
心血管疾病（CVDs）是加拿大总死亡人数的第二大主要原因。高血压是 CVDs 发展的主要代谢风险因素。已经证实，过量摄入钠会对血压产生不利影响。加拿大人的平均钠摄入量远远高于推荐水平。通过食品配方改革减少饮食中的钠摄入量已被确定为一种具有成本效益的干预措施，然而，在加拿大，尚未确定饮食中的钠摄入量以及由于食品配方改革而达到推荐的钠摄入量水平对健康的潜在影响。
本研究旨在：1）获得加拿大人通常的钠摄入量的可靠估计值；2）通过模型模拟如果食物根据加拿大健康署的钠减少目标进行配方改革，钠摄入量会如何变化；3）如果加拿大成年人将其平均钠摄入量减少至以下三种情况下的推荐水平，估计可预防或延迟的 CVD 死亡人数：A）2300mg/d-通过降低包装食品中的钠含量以达到加拿大健康署的目标（配方改革）；B）2000mg/d-符合世界卫生组织（WHO）的建议；C）1500mg/d-符合适宜摄入量的建议。
将多伦多大学食品标签信息计划 2017 中的食品与 2015 年加拿大社区健康调查-营养的全国代表性食物摄入量数据相联系，以估计钠摄入量（并假设加拿大健康署的配方改革策略已全面实施）。使用预防风险综合模型（PRIME）来估计潜在的健康影响。
总体而言，平均钠摄入量为 2758mg/天，按年龄和性别组有所不同。根据方案 A 的“配方改革”，钠摄入量减少了 459mg/天，至 2299mg/天。在方案 A、B 和 C 下，将加拿大人的钠摄入量减少至推荐水平，可分别预防或延迟 2176 例（95%置信区间 869-3687）、3252 例（95%置信区间 1380-5321）和 5296 例（95%置信区间 2190-8311）因 CVD 导致的死亡，主要来自缺血性心脏病、中风和高血压疾病。这分别占 2019 年加拿大 CVD 死亡总人数的 3.7%、5.6%和 9.1%。
结果表明，将钠摄入量减少至推荐水平可以预防或延迟加拿大大量的 CVD 死亡。通过改革加拿大的食品供应可以减少钠的摄入量。然而，要实现加拿大健康署的自愿基准钠减少目标，需要食品行业更高的合规性。
