ARGENTINE INITIATIVE TO REDUCE SODIUM CONSUMPTION
“Less Salt, More Life”
Background
• Salt consumption
p
in Argentina
g
is estimated to be 12-13 g
gr.
per day/hab
• WHO and FAO recomends a daily salt consumption < 5 gr.
d /h b
day/hab
• There is consistent scientific evidence linking excessive salt
intake
ta e w
with
t high
g blood p
pressure
essu e a
and
d tthe
e ralationship
alat o s p iss d
direct
ect
and progressive
• Lowering blood pressure by reducing dietary salt at a
population
l i
l
level
l can reduce
d
premature deaths
d h due
d
to CVD
and kidney disease
• Population level salt reduction initiatives are considered one
of the most cost efective strategies
• Progressive salt reduction has the advantage of not being
perceived by the population due to taste adjustment
Health consequences of excessive salt consumption
¾ Increase in blood pressure and risk of developing CVD:
•Stroke
•Coronaryy heart disease
•Kidney disease
¾ Direct effects (independently of BP)
•Increase risk of stroke
•Myocardial hypertrophy
•Proteinuria and kidney disease
¾ Indirect effects: Obesity
¾ Other effects: stomach cancer, osteoporosis, renal stones, asthma
exacerbations
He F., MacGregor G., A comprehensive review on salt and health and current experience of worldwide salt
reduction programmes.
programmes Journal of Human Hypertension(2009)23,363–384
Hypertension(2009)23 363 384
LESS SALT, MORE LIFE
Aims to reduce population
population´ss salt consumption with the objective of
reducing the burden of disease that generates cardiovascular and kidney
diseases
Is among the most important health promotion strategies that the MoH is
implementing and is a component of the Comprehensive Strategy of
Control and Prevention of NCDs
Components
1- Increase population awareness about the salt health effects and the
1
need of reducing salt addition to food
2- Reduction of salt content in handmade manufactured bread through
voluntary agreements with bakeries
3- Progressive reduction of salt content in processed food through
voluntary agreements with the big food industry
The voluntary agreements with handmade
manufacturers of bread aims to reduce 25 %
the salt content of bread at bakeries.
bakeries These
agreements were sponsored by the baker´s
union and the National Institute of Industrial
Technology (FAIPA and INTI)
National Comitee for salt reduction and trans fatty acids elimination
•
•
•
•
•
Ministry
Mi
i t off Health
H lth
Ministry of Agriculture
Ministry of Social Development
Mi i
Ministry
off Science
S i
and
d Technology
T h l
SENASA , INTI
Establishment of 4 workgroups related to
the food category: 1.Meat and cold cuts, 2 dairy products 3 bread and biscuits 4
2.dairy products, 3.bread and biscuits, 4. Soups and canned food
Modification of the
Alimentary law
“Argentina libre de
trans 2014”
Comunication
strategies
•INAL
INAL - DENT – CN ONGs
ONG
•COPAL
•Universities /Propia
•Food Industryy Unions
•FAIPA, ASAGA
•Cooperatives
1- Baseline
1
B li
diagnosis
2- negotiation
2
ti ti with
ith
food industry for
the settlement of
targets of each
g p
group
3‐Sign of agreements
3
Si
f
t
with the obligation of companies to reduce salt content
4‐Evaluation l
and surveillance
Agreements with food industry
Big health impact
Technologically feasible
Progressive and accepted by consumers
T
Targets
t a reduction
d ti 5-18
5 18 % in
i two
t
years in
i maximum
i
or
average sodium content (depending on each product)
• Could reach
eac new
ew p
products
oducts
• 25 companies signed the agreement
•
•
•
•
Companies that signed the
agreement
Beginning
Agreement
records
model for provinces
DISEMINATION
Encourage
Provincial
agreements
documents organization
Framework
C
Convention
ti for
f
voluntary
progressive salt
reduction
INAL and health
promotion stakeholders
Monitoring
Cometee
MEASURES
database
I f
Information
ti
management
REGISTRY
10
Framework Convention for voluntary progressive salt reduction
adherence
MSN, MAG,
COPAL
3 Chambers
Cámara
Argentina
Cá
A g ti de
d la
l
Industria de Chacinados y
Afines (CAICHA)
Cámara
de
Cá
d Industriales
I d t i l de
d
Productos Alimenticios
(CIPA)
adherence
16 companies
12 new adherences
Centro
de lla IIndustria
C t d
d t i
Lechera
(CIL)
Coordinated Monitoring Plan
Process evaluation
Food salt content
Sodium intake
measurement
Reports
Sworn statement
and update of
labelling. Analysis
by INAL
laboratories
Sodium intake
Surveys and
urinary sodium
measurement (La
Pampa)
Intersectorial Comission
Institutional roles
• National: Rectory, facilitate, big food industry
agreements sensibilization and monitoring
agreements, sensibilization
and monitoring plan
• Provincial
Provincial and/or
and/or municipal. Local food
municipal Local food industry
agreements and sensibilization. Help with monitoring
p
plan at a local level
Provincial Units and Strategies of Health Promotion
Estimated impact
• Modeling of the
of the intervention
(reduction of 3gr)
• CHD Policy
C
li Model
d l
• STELLA software (system dynamics)
• We estimate that a 3 gr. salt reduction
,
cardiovascular
in diet could avoid 6,000
deaths, 13,000 myocardial infarctions
,
strokes
and 13,000
•
Prevalence of hypertension
of hypertension
36
37
Prevalencia de Hipertension Arterial. Proyecciones Caso Base y con Intervencion
34
33
Less Salt More Life
32
Prevalencia %
35
35.7%
30
0
31
31.7%
2005
2006
2007
2008
2009
Caso Base
Source: own production
2010
2011
Año
2012
2013
2014
Caso con Intervencion
2015
2016
Potential impact on coronary heart disease
( f d i 3 gr.)
(of reducing
3 )
0%
35‐44
45‐54
55‐64
65‐74
‐5%
‐10%
‐15%
‐20%
‐25%
‐30%
Hombres
Mujeres
j
75‐84
Potential impact on stroke
( f d i 3 gr.)
(of reducing
3 )
0%
35‐44
45‐54
55‐64
‐5%
‐10%
‐15%
‐20%
‐25%
‐30%
Hombres
Mujeres
65‐74
75‐84
•
•
•
•
•
Conclusions
These voluntary agreements are an example of coordinated
policies between state, unions and industries
Progressive sodium reduction could be an effort of
companies towards increasing their social responsability
There is a need of increasing the number of companies that
adhere and a need of setting new and progressive targets
It is crucial the participation of provinces to be able to
reach local and small food industries
Less Salt More Life Initiative constitutes an example of a
population level salt reduction approach and could be
replicated in other countries
Thank you