在澳大利亚包装食品中强制设定钠基准的健康影响、成本和成本效益估计：一项建模研究。

Estimated health effect, cost, and cost-effectiveness of mandating sodium benchmarks in Australia's packaged foods: a modelling study.

机构信息

The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia; Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA; Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia.

出版信息

Lancet Public Health. 2024 Nov;9(11):e861-e870. doi: 10.1016/S2468-2667(24)00219-6.

DOI:10.1016/S2468-2667(24)00219-6

PMID:39486902

Abstract

BACKGROUND

Excess dietary sodium is a leading cause of death and disability globally. Because packaged foods are a major source of sodium in many countries, including Australia, mandatory limits for sodium might improve population health. We aimed to estimate the long-term health and economic effect of mandating such thresholds in Australia.

METHODS

We used a multiple cohort, proportional, multistate, life table model to simulate the effect of mandating either the WHO global sodium benchmarks or the currently non-mandatory Australian Healthy Food Partnership (HFP) sodium targets. We compared maintaining the current sodium intake status quo with intervention scenarios, using nationally representative data on dietary intake, sodium in packaged foods, and food sales volume. Blood pressure and disease burden data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study. 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 calculate the incremental cost per health-adjusted life-year (HALY) gained. Costs and HALYs were discounted annually at 3%.

FINDINGS

Compared with the status quo intervention, mandating the WHO benchmarks could be cost saving over the first 10 years (AUD$223 [95% uncertainty interval 82-433] million saved), with 2743 (1677-3976) cardiovascular disease deaths and 43 971 (26 892-63 748) incident cardiovascular disease events averted, and 11 174 (6800-16 205) HALYs gained. Over the population's lifetime, the intervention was cost effective (100·0% probability). Mandating the HFP sodium targets was also estimated to be cost effective (100·0% probability), but with 29% of the health benefits compared with the WHO benchmarks.

INTERPRETATION

Our modelling study supports mandating sodium thresholds for packaged foods as a cost-effective strategy to prevent death and disease in Australia. Although making Australia's voluntary reformulation targets mandatory might save thousands of lives, mandating the WHO global benchmarks could yield substantially greater health gains.

FUNDING

None.

摘要

背景

摄入过多的钠是造成全球范围内死亡和残疾的主要原因之一。由于包装食品是许多国家（包括澳大利亚）钠的主要来源，因此强制设定钠含量的限值可能会改善人群健康。我们旨在评估在澳大利亚实施此类限量标准对健康和经济的长期影响。

方法

我们使用多队列、比例、多状态、生命表模型来模拟强制实施世界卫生组织（WHO）全球钠基准或目前非强制性的澳大利亚健康食品伙伴关系（HFP）钠目标的效果。我们使用全国代表性的饮食摄入、包装食品中的钠含量以及食品销售量数据，将维持当前钠摄入量现状与干预情景进行了比较。我们从全球疾病、伤害和危险因素研究（Global Burden of Diseases, Injuries, and Risk Factors Study）中获取了血压和疾病负担数据。根据随机试验和队列研究的荟萃分析，我们对钠摄入量减少对血压和疾病风险的影响进行了建模。我们使用干预和医疗保健成本来计算每获得一个健康调整生命年（health-adjusted life-year，HALY）的增量成本。成本和 HALY 每年按 3%贴现。

结果

与现状干预相比，强制实施 WHO 基准可能在最初 10 年内具有成本效益（节省 2.23 亿澳元[95%置信区间 8200 万至 4.33 亿]），可预防 2743 例（1677 至 3976 例）心血管疾病死亡和 43971 例（26892 至 63748 例）心血管疾病事件，以及 11174 例（6800 至 16205 例）HALY。在人群的一生中，该干预措施是具有成本效益的（100.0%的概率）。强制实施 HFP 钠目标也被估计为具有成本效益（100.0%的概率），但与 WHO 基准相比，其健康效益仅占 29%。