The epidemiological burden of reducing salt intake in Paraguay

A modeling study

Authors

Keywords:

Salt, Sodium, Cardiovascular disease, Mortality, Hypertension, Non-communicable disease, Paraguay

Abstract

Objective
This study aims to estimate the epidemiological burden of excessive salt intake reduction and achieve the World Health Organization salt reduction target for 2025 in Paraguay, in 2019.
Methods
We used the Preventable Risk Integrated Model, a comparative risk assessment macrosimulation model, to estimate the averted deaths, disease incidence, and disability-adjusted life years from cardiovascular disease attributable to salt intake in the population of Paraguay for different salt reduction policy scenarios.
Results
As a result, in Paraguay, excessive salt intake (over 5 g/day) is responsible for approximately 2,656 cardiovascular disease deaths (95% Uncertainty Interval: 1,250-3,765), 4,816 cardiovascular disease cases (95% UI: 2,251-6,947), and 60,529 disability-adjusted life years (95% UI: 27,828- 86,258) per year. By reducing salt consumption by 30%, as recommended by the World Health Organization until 2025, approximately 1,188 deaths (95% UI: 520 to 1,820), 2,100 incident cases (95% UI: 923-3,234), and 27,272 disability-adjusted life years (95% UI: 11,999-41,675) from cardiovascular disease could be averted every year.
Conclusion
In conclusion, the burden of cardiovascular disease attributable to excessive salt intake is significant and salt reduction policies must become a priority in Paraguay.

References

Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1736-88. https://doi.org/10.1016/s0140-6736(18)32203-7

Dong C, Bu X, Liu J, Wei L, Ma A, Wang T. Cardiovascular disease burden attributable to dietary risk factors from 1990 to 2019: a systematic analysis of the Global Burden of Disease Study. Nutr Metab Cardiovasc Dis. 2022;32(4):897-907. https://doi.org/10.1016/j.numecd.2021.11.012

Ministerio de Salud Pública y Bienestar Social (Paraguay). Manual de Manejo de Enfermedades Crónicas no Transmisibles desde la Atención Primaria de Salud [Internet]. Asunción: Ministerio; 2015 [cited May 2023 13]. Available from: https://dvent.mspbs.gov.py/manual-de-manejo-de-enfermedades-cronicas-no-transmisibles/

World Health Organization. Noncommunicable diseases [Internet]. Geneva: Organization; 2023 Sep 16 [cited 2022 May 13]. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

Migliaccio S, Brasacchio C, Pivari F, Salzano C, Barrea L, Muscogiuri G, et al. What is the best diet for cardiovascular wellness? A comparison of different nutritional models. Int J Obes Suppl. 2020;10(1):50-61.

He FJ, Tan M, Ma Y, MacGregor GA. Salt Reduction to Prevent Hypertension and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;75(6):632-47. https://doi.org/10.1016/j.jacc.2019.11.055

Zhou B, Perel P, Mensah GA, Ezzati M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol. 2021;18(11):785-802.

Grillo A, Salvi L, Coruzzi P, Parati G. Sodium Intake and Hypertension. Nutrients. 2019;11(9):1-16.

World Health Organization. Updating Appendix 3 of the WHO global action plan for the prevention and control of noncommunicable diseases 2013–2030 [Internet]. Geneva: Organization; 2022 [cited 2023 May 13]. Available from: https://www.who.int/teams/noncommunicable-diseases/updating-appendix-3-of-the-who-global-ncd-action-plan-2013-2030/

Grajeda R, Hassell T, Ashby-Mitchell K, Uauy R, Nilson E, Hassel T, et al. Regional Overview on the Double Burden of Malnutrition and Examples of Program and Policy Responses : Latin America and the Caribbean. Ann Nutr Metab. 2019;75(2):139-43.

Ministerio de Salud Pública y Bienestar Social (Paraguay). Boletin de Vigilancia Número 4 – Enfermedades no Transmisibles y Factores de Riesgo [Internet]. Asunción; 2021 [cited 2022 May 13]. Available from: https://dvent.mspbs.gov.py/boletin-2020-2/

Pedrozo ME, Assis D, Cabello A, Cañete F, Prieto-Alvarado F, Barengo NC. Determinación de sodio urinario como marcador bioquímico para estimar la ingesta de sal en trabajadores del Ministerio de Salud Pública y Bienestar Social, Paraguay. Mem Inst Investig Cienc Salud. 2021;19(3):61-72. https://doi.org/10.18004/mem.iics/1812-9528/2021.019.03.61

Pan American Health Organization. Mapping dietary salt/sodium reduction policies and initiatives in the Region of the Americas [Internet]. Washington: Organization; 2021 [cited 2023 May 13]. Available from: https://iris.paho.org/bitstream/handle/10665.2/55056/9789275123232_eng.pdf?sequence=1&isAllowed=y

Instituto Nacional de Estadística (Paraguay). Proyección de la población nacional, áreas urbana y rural por sexo y edad, 2000-2025. [Internet]. Paraguay: Instituto; 2015 [cited May 2023 13]. Available from: https://www.ine.gov.py/default.php?publicacion=2

Institute for Health Metrics and Evaluation. Global burden of disease 2019 [Internet]. Seattle: Institute; 2020 [cited 2023 May 13]. Available from: https://vizhub.healthdata.org/gbd-compare

Scarborough P, Harrington RA, Mizdrak A, Zhou LM, Doherty A. The Preventable Risk Integrated ModEl and its use to Estimate the Health Impact of Public Health Policy Scenarios. Scientifica. 2014;748750. https://doi.org/10.1155/2014/748750

Trieu K, Coyle DH, Afshin A, Neal B, Marklund M, Wu JHY. The estimated health impact of sodium reduction through food reformulation in Australia: a modeling study. Plos Med. 2021;18(10):e1003806. https://doi.org/10.1371/journal.pmed.1003806

Nilson EAF, Metzler AB, Labonte M-E, Jaime PC. Modelling the effect of compliance with WHO salt recommendations on cardiovascular disease mortality and costs in Brazil. Plos One. 2020;15(7):e0235514. https://doi.org/10.1371/journal.pone.0235514

Vega-Solano J, Blanco-Metzler A, Madriz-Morales K, Fernandes-Nilson E-A, Labonté ME. Impact of salt intake reduction on CVD mortality in Costa Rica: a scenario modelling study. Plos One. 2021;16(1):e0245388. https://dx.plos.org/10.1371/journal.pone.0245388

Allemandi L, Tiscornia MVMMV, Guarnieri L, Castronuovo L, Martins E. Monitoring sodium content in processed foods in Argentina 2017–2018: compliance with national legislation and regional targets. Nutrients. 2019;11(7):e1474. https://doi.org/10.3390/nu11071474

World Health Organization. SHAKE the salt habit -The SHAKE technical package for salt reduction [Internet]. Geneva: Organization; 2016 [cited 2023 May 13]. Available from: https://www.who.int/dietphysicalactivity/publications/shake-salt-habit/en/

Ide N, Ajenikoko A, Steele L, Cohn J, Curtis CJ, Frieden TR, et al. Priority Actions to Advance Population Sodium Reduction. Nutrients. 2020;12(9):2543. http://dx.doi.org/10.3390/nu12092543

Hyseni L, Elliot-Green A, Lloyd-Williams F, Kypridemos C, O’Flaherty M, McGill R, et al. Systematic review of dietary salt reduction policies: Evidence for an effectiveness hierarchy? Plos One. 2017;12(5):e0177535. https://doi.org/10.1371/journal.pone.0177535

Laverty AA, Kypridemos C, Seferidi P, Vamos E, Pearson-Stuttard J, Collins B, et al. Quantifying the impact of the Public Health Responsibility Deal on salt intake, cardiovascular disease and gastric cancer burdens: interrupted time series and microsimulation study. J Epidemiol Community Health. 2018;73(9):881-7. https://doi.org/10.1136/jech-2018-211749

Ricardo CZ, Andrade GC, Salvador BC, Mais LA, Duran AC, Martins APB. Adesão aos acordos voluntários de redução de sódio no Brasil. Cien Saude Colet. 2022;27(2):701-10. https://doi.org/10.1590/1413- 81232022272.45702020

Nilson EAF, Pearson-Stuttard J, Collins B, Guzman-Castillo M, Capewell S, O’Flaherty M, et al. Estimating the health and economic effects of the voluntary sodium reduction targets in Brazil: microsimulation analysis. BMC Med. 2021;19(1):1-10. https://doi.org/10.1186/s12916-021-02099-x

Nilson EAF, Spaniol AM, Andrade RCS, Silva SA. Estratégias para redução do consumo de nutrientes críticos para a saúde: o caso do sódio. Cad Saude Publica. 2021;37(Suppl 1):e00145. http://dx.doi.org/10.1590/0102- 311X00145520

Pan American Health Organization. Updated PAHO Regional Sodium Reduction Targets [Internet]. Washington: Organization; 2021 [cited 2023 May 13]. Available from: https://iris.paho.org/bitstream/handle/10665.2/54658/PAHONMHRF210016_eng.pdf?sequence=1&isAllowed=y

World Health Organization. WHO global sodium benchmarks for different food categories [Internet]. Geneva: Organization; 2021 [cited 2023 May 13]. Available from: https://www.who.int/publications/i/item/9789240025097

International Development Research Centre. Scaling Up and Evaluating Salt Reduction Policies and Programs in Latin American Countries [Internet]. Ontario: IDRC; 2020 [cited 2023 May 13]. Available from: https://www.idrc.ca/en/project/scaling-and-evaluating-salt-reduction-policies-and-programs-latin-american-countries

Madriz K, Ramos E, Blanco-Metzler A, Saavedra L, Nilson E, Tiscornia V, et al. Policy Brief: El desafío de reducir el consumo de sal/sodio en la dieta de la población latinoamericana. Proyecto - IDRC 108167 Escalando y evaluando políticas y programas de reducción de sal en países de América Latina. 2016-2019. [Internet]. Tres Rios: El Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud; 2020 [cited 2023 May 13]. Available from: https://idl-bnc-idrc.dspacedirect.org/bitstream/handle/10625/58947/IDL-58947.pdf?sequence=2

Published

2023-11-22

How to Cite

BURGOS, R., SANTACRUZ, E., DUARTE-ZOILAN, D., TURNES, C., BENITEZ, G., & NILSON, E. A. F. (2023). The epidemiological burden of reducing salt intake in Paraguay: A modeling study. Brazilian Journal of Nutrition, 36. Retrieved from https://seer.sis.puc-campinas.edu.br/nutricao/article/view/10474

Issue

Section

ORIGINAL ARTICLE