The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
Lancet Public Health. 2024 Nov;9(11):e852-e860. doi: 10.1016/S2468-2667(24)00221-4.
Excess dietary sodium intake has been associated with death and disability. WHO has released global sodium benchmarks for packaged foods to support countries to reduce population sodium intake. This study aimed to assess the potential health effect, costs, and cost effectiveness of implementing these WHO sodium benchmarks in India.
We used a multiple cohort, proportional multistate, life table (Markov) model to estimate the health gains and cost effectiveness for adults if sodium content in packaged foods complied with the WHO benchmarks compared to the status quo. We used India-specific dietary surveys, food composition tables, foods sales data, and sodium content data from packaged food labels to estimate sodium intake before and after the intervention. Data on blood pressure, cardiovascular disease, and chronic kidney disease burden were obtained from the Global Burden of Diseases, Injuries, and Risk Factors study, and the effect of sodium reduction on blood pressure and disease risk was modelled on the basis of meta-analyses of randomised trials and cohort studies. Intervention and health-care costs were used to estimate net costs, and calculate the incremental cost per health-adjusted life-year (HALY) gained. Costs and HALYs were discounted at 3%.
In the first 10 years, compliance with the WHO sodium benchmarks was estimated to avert a mean of 0·3 (95% uncertainty interval [UI] 0·2-0·5) million deaths from cardiovascular diseases and chronic kidney disease, a mean of 1·7 (95% UI 1·0-2·4) million incident cardiovascular disease events, and 0·7 (0·4-1·0) million new chronic kidney disease cases, compared with current practice. Over 10 years, the intervention was projected to be cost saving (100·0% probability), generating 1·0 (0·6 to 1·4) billion HALYs and US$0·8 (95% UI 0·3 to 1·4) million in cost savings. Over the population lifetime, the intervention could prevent 4·2 (2·4-6·0) million deaths from cardiovascular diseases and chronic kidney disease, 14·0 (8·2-20·1) million incident cardiovascular disease events, and 4·8 (2·8-6·8) new chronic kidney disease cases, with an 84·2% probability of being cost-saving and 100·0% probability of being cost-effective.
Our modelling data suggest a high potential for compliance with WHO sodium benchmarks for packaged food being associated with substantial health gains and cost savings, making a strong case for India to mandate the implementation of the WHO sodium benchmarks, particularly as packaged food consumption continues to rise.
WHO Country Office India.
过量的膳食钠摄入与死亡和残疾有关。世界卫生组织发布了包装食品的全球钠基准，以支持各国减少人群的钠摄入量。本研究旨在评估在印度实施这些世卫组织钠基准的潜在健康效果、成本和成本效益。
我们使用多队列、比例多状态、生命表（马尔可夫）模型来估计，如果包装食品中的钠含量符合世卫组织基准，而不是现状，成年人的健康收益和成本效益。我们使用印度特定的饮食调查、食物成分表、食品销售数据和包装食品标签上的钠含量数据来估计干预前后的钠摄入量。血压、心血管疾病和慢性肾脏病负担的数据来自全球疾病、伤害和风险因素研究，根据随机试验和队列研究的荟萃分析，对钠减少对血压和疾病风险的影响进行建模。干预和医疗保健成本用于估计净成本，并计算每获得一个健康调整生命年（HALY）的增量成本。成本和 HALYs 贴现率为 3%。
在最初的 10 年内，遵守世卫组织钠基准估计可避免因心血管疾病和慢性肾脏病而导致的平均 0.3（95%置信区间 [95%UI] 0.2-0.5）百万人死亡，平均 1.7（95%UI 1.0-2.4）百万例心血管疾病事件和 0.7（0.4-1.0）百万例新发慢性肾脏病病例，与当前做法相比。在 10 年内，预计该干预措施将具有成本效益（100.0%的概率），产生 1.0（0.6-1.4）亿 HALYs 和 8000 万美元（95%UI 0.3-1.4 亿美元）的成本节约。在人群的一生中，该干预措施可预防 4.2（2.4-6.0）百万人因心血管疾病和慢性肾脏病死亡，14.0（8.2-20.1）百万人发生心血管疾病事件和 4.8（2.8-6.8）例新发慢性肾脏病病例，具有 84.2%的成本效益概率和 100.0%的成本效益概率。
我们的模型数据表明，遵守世卫组织关于包装食品的钠基准，与大幅改善健康和节约成本有很大关系，这强烈表明印度需要强制实施世卫组织的钠基准，特别是随着包装食品消费的持续增长。
世卫组织印度国家办事处。
