New Study Provides Basis for Setting Maximum Sodium Limits for Prepackaged Foods in China

【Summary Description】 The salt intake of our population has been decreasing year by year, but the per capita salt intake is still very high (11 g/day), more than twice the amount recommended by the World Health Organization (WHO) (no more than 5 g/day).

      The salt intake of our population has been decreasing year by year, but the per capita salt intake is still very high (11 g/day), more than twice the amount recommended by the World Health Organization (WHO) (no more than 5 g/day).
 
　　Adults consume an average of 1302.5 mg of sodium per day from prepackaged foods (including condiments such as soy sauce), accounting for about 30% of all sodium intake.
 
　　Setting a maximum sodium limit for prepackaged foods is an important salt reduction strategy that has been adopted by 65 countries around the world. 2021 WHO released a global sodium benchmark with reference to the minimum value of each country's limit to support countries in accelerating their salt reduction efforts; however, due to the lack of a reliable sodium limit, China has not yet implemented this salt reduction strategy.
 
　　In order to support the implementation of this salt reduction strategy, this study, based on the sodium content data of 15,000 residents' food consumption and more than 50,000 types of pre-packaged foods for sale, and on the basis of simulating the effects and possible impacts of multiple sets of maximum sodium limit standards, finally determined the optimal maximum sodium limit standard system of "average sodium reduction of 20%", which not only ensures the effective salt reduction (20%) of various types of foods, but also provides the following information It not only ensures an effective salt reduction (around 20%) for various food products, but also ensures the acceptability of the change in taste to consumers and food companies as far as possible.
 
　　Although most of the above proposed standards are not up to the WHO global sodium benchmark level, the maximum sodium limits proposed in this study should be of good reference value as a starting target to promote progressive salt reduction in prepackaged foods.
 
　　A study recently published in the Bulletin of the World Health Organization compares several salt reduction strategies for setting sodium limits for prepackaged foods and analyzes the pros and cons of implementation in China. The study concluded that a fine-tuned maximum sodium limit of "20% average sodium reduction" was proposed and recommended to be adopted at the initial stage of setting the standard in China. Theoretically, this set of standards could significantly reduce sodium levels in prepackaged foods, while still being acceptable to consumers and food manufacturers. The research team came from the Institute of Nutrition and Health of the Chinese Center for Disease Control and Prevention, the George Institute for Global Health, Queen Mary University of London and the World Health Organization. The researchers explored ways to establish maximum sodium limits for prepackaged foods in China, taking into account WHO's global benchmarks for sodium limits for various types of foods and the methodology for setting them.
 
　　Data Sources
 
　　Data for the study were obtained from two national databases, including 51,803 items of nutritional information on prepackaged foods and 3 consecutive days of food consumption information from 15,670 Chinese adult residents. All products were re-categorized based on the WHO Sodium Benchmark Food Classification Framework, with fine-tuning to take into account China's advantageous products and sodium levels. The study analyzed the sodium content of prepackaged foods in China and its contribution to the population's sodium intake, and compared the impact of different sodium limit setting methods on the reduction of national sodium intake and the proportion and magnitude of formulation adjustments made by enterprises, with a view to proposing the most reasonable and feasible standard system for maximum sodium limits of prepackaged foods, and providing evidence for the formulation of relevant policies in China.
 
　　Results of the Study
 
　　The results of the study showed that Chinese adults consumed 1302.5 mg/day (equivalent to 3.3 g of salt) of sodium from prepackaged foods, which accounted for 30.1% of the one-day sodium intake; the highest sodium intake was from soy sauce and oyster sauce, followed by instant foods and salted butter. Establishing different sodium limits could reduce per capita sodium intake by 1.9% to 13.9%. For example, if all prepackaged foods could meet the WHO global sodium limit benchmarks, the national sodium intake from prepackaged foods would be reduced by 701 mg/day, accounting for 13.9% of the per capita salt intake. However, taking into account the current situation of sodium content in food and the level of salt intake of the population in China, China's target of 20% salt reduction by 2030, as well as the acceptability of consumers and enterprises, the research team finally proposed a threshold standard of 20% average sodium reduction for each type of food, and fine-tuned the threshold based on the criterion of no less than 10% for improved products. The effective implementation of this set of standards can reduce sodium intake from prepackaged food by 305 mg per day, which is equivalent to 6.1% less salt per day, and within a reasonable range to help achieve China's salt reduction goals. Of course, this set of standards can also be continuously adjusted to gradually move closer to the WHO global sodium benchmark.
 
　　This study provides a basis for accelerating the process of salt reduction in prepackaged foods in China. 1.7 million deaths in China in 2017 were caused by high-salt diets, and 6 million cardiovascular and cerebrovascular diseases would be averted by 2030 if the sodium limits proposed in this study were met.
 
　　Professor Zhang Puhong, author of the paper and deputy director of the George Institute for Global Health (China), noted:
 
　　"In recent decades, China has carried out a number of salt reduction efforts targeting the household and food service sectors, with residential household salt use decreasing from 10.4 g/day in 2010-2012 to 9.3 g/day in 2015; however, substantial progress has yet to be made in reducing salt in prepackaged foods. This study found that nearly one-third of salt intake comes from prepackaged foods (including all types of condiments), and that sales of prepackaged foods have been increasing year after year. It is easier and more sustainable for food companies to reduce salt consumption than to change people's cooking and eating habits. We hope to receive wider attention and support from all sectors of society on salt reduction in prepackaged foods, to promote the formulation of policies related to the maximum sodium content standard for prepackaged foods, and to deepen China's salt reduction initiatives."
 
　　Wang Huijun, corresponding author of the paper and researcher at the Institute of Nutrition and Health, Chinese Center for Disease Control and Prevention, said:
 
　　"Establishing nutrition laws, policies and standards applicable to China's national conditions has always been the focus of China's national nutrition program. International experience has proven that the establishment of sodium limits to encourage food companies to reduce salt use is a practical way to reduce salt, and China is also actively exploring feasible policies to reduce salt through pre-packaged foods. This set of standards based on the "average sodium reduction of 20%" is the best recommendation after weighing the effect of salt reduction and the feasibility of formula adjustment ratio and other indicators, and its clear scope and magnitude of food improvement will help enterprises to implement, while also taking into account the gradual adaptation of consumer tastes, as well as to avoid a huge impact on the market. "
 
　　Ding Gangqiang, director of the Institute of Nutrition and Health at the Chinese Center for Disease Control and Prevention, noted:
 
　　"This study provides an important scientific reference for setting sodium standards for prepackaged foods in China, but this strategy also needs to go hand in hand with various types of salt reduction measures, including those targeting the reduction of cooking salt."