View
212
Download
0
Category
Preview:
Citation preview
84 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2012 vol. 36 no. 1© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia
Excess sodium intake has multiple
adverse health effects, the most
important of which is its effect
on blood pressure.1 Hypertension (or high
blood pressure) is a major risk factor for the
development of cardiovascular disease,2 the
leading cause of premature death in New
Zealand (NZ).3 Cardiovascular disease is
responsible for 41% of all NZ deaths annually3
and is associated with significant economic
costs4 and negative impacts on quality of life
for patients.5 Although there are currently
no accurate, recent data regarding New
Zealanders’ sodium intakes, the population
average is estimated to be about 3,600 mg
(9 g of salt) per day,6 well above the Nutrient
Reference Value for Australia and NZ (2,300
mg sodium/6 g salt).7
The majority of sodium (~75%) consumed
in high-income countries comes from
processed/packaged foods.8 Consequently,
there is increasing interest in reformulation of
available foo d products to lower their sodium
content. Small reductions in sodium such as
those achieved through reformulation could
play an important role in reducing the burden
of nutrition-related disease in NZ: it has been
estimated that an average reduction of 1,000
mg of dietary sodium (2.5 g salt) per day could
lead to an overall decrease of 1.0 mmHg in
mean population systolic blood pressure and
avert about 282 deaths and 2,613 years of life
lost per year from heart disease and stroke.3
Thirty-two countries globally have sodium
reduction strategies, 26 of which are led by
Governments and 28 include working with
the food industry to reformulate processed
foods.9 Manufacturer food reformulation
efforts to date have largely focused on meeting
various nutrient targets set internationally
by Government and advocacy groups. For
example, in 2006 the United Kingdom (UK)
set sodium reduction targets for 85 food
categories with the aim of reducing population
sodium intake to approximately 2,300 mg
(6 g of salt) per day.10 Efforts have also been
made by the Australian Food and Health
Dialogue, which has been working with the
food industry since 2010 to voluntarily reduce
sodium levels across a range of breads, ready-
to-eat breakfast cereals, simmer sauces and
processed meats.11 Interim sodium targets
for 85 categories of Australian processed
foods were recently released by the Australian
Division of the World Action on Salt and
Health.12 Similar sodium targets for processed
foods are currently being developed by
Health Canada,13 and in the United States
food companies are working together to meet
sodium reduction targets for packaged and
restaurant foods.14
Despite population sodium intakes
being higher than recommended dietary
guidelines,6,7 NZ does not have a national
sodium reduction strategy. Nonetheless, in
2007, the Heart Foundation of NZ initiated
Project Target 450, a voluntary initiative with
bread manufacturers to reduce the sodium
content of low-cost, high-volume bread
products to ≤450 mg/100 g. The project has
achieved reductions in the sodium content of
NZ breads, with the mean sodium content
Abstract
Objective: To identify key opportunities for
reformulation of processed foods that could
best decrease population sodium intakes
in New Zealand (NZ).
Method: Relevant national literature
and reports were used to identify major
food groups contributing to population
sodium intakes in NZ. Sodium content
data for these food groups were collected
from the Nutrition Information Panels of
processed foods in one large supermarket.
Key opportunities for reformulation were
identified by comparing mean sodium
content with 2012 targets from the United
Kingdom (UK) Food Standards Agency
(FSA) and mean sodium values from
Australia and the UK.
Results: Major contributors to NZ sodium
intakes are: bread (26%), processed
meats (10%), and sauces (6%). Mean
(SD) sodium contents of these processed
foods were: 447 (125) mg/100 g, 1,169
(444) mg/100 g, and 1,046 (1,235)
mg/100 g, respectively. Food categories
with the lowest percentage of products
meeting corresponding FSA targets were:
sausages/hot dogs and sliced meat (0%);
salami/cured meat (2%); liquid meal-based
sauces (4%); and multigrain bread (14%).
Mean sodium contents of NZ products
were higher than for similar products in the
UK. Key opportunities identified for sodium
reduction were: white bread, sausages and
hot dogs, and salami/cured meats.
Conclusion: There is substantial scope
to reduce the sodium content of NZ
processed foods.
Implications: This paper identifies
three key opportunities for reformulation
of processed foods that could produce
substantial decreases in sodium intakes in
NZ, and benefits to population health.
Key words: sodium, food supply, New
Zealand, public health
Aust NZ J Public Health. 2012; 36:84-9
doi: 10.1111/j.1753-6405.2012.00829.xSubmitted: June 2011 Revision requested: August 2011 Accepted: October 2011Correspondence to: Helen Eyles, Clinical Trials Research Unit, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, New Zealand; e-mail: h.eyles@ctru.auckland.ac.nz
Key opportunities for sodium reduction
in New Zealand processed foods
Eleanor Woodward, Helen Eyles, Cliona Ni MhurchuClinical Trials Research Unit, The University of Auckland, New Zealand
Policy Failure Article
2012 vol. 36 no. 1 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 85© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia
dropping by 34 mg/100 g (from 469 to 439 mg/100 g) between
2007 and 2010.15 Project Target 450 has now been extended to
other food categories.16 The project supplements the established
Heart Foundation Tick program, a manufacturer-sponsored initiative
promoting healthier food choices and manufacturer reformulation
within food categories.17,18
Systematic surveys of the sodium contents of processed foods
have been undertaken in Australia and the United Kingdom,19,20
and the development of a global collaboration on food composition
monitoring (led by the Australian World Action on Salt and Health), is
under way.21 However, there has been no systematic evaluation of the
sodium content of the NZ food supply. Such information is critical to
inform food manufacturers, public health advocates, and Government
regarding the most promising food reformulation strategies to reduce
sodium and improve public health. Furthermore, it would enable NZ
to contribute to the global collaboration through provision of data to
the global food composition database, a particular goal of which is to
encourage removal of sodium in processed foods. Reducing sodium
intake has been identified by the World Health Organization (WHO)
as one of the ‘best buys’ for cutting deaths from non-communicable
disease,22 and mandatory and voluntary reductions in the sodium
content of processed food have been found to be cost-saving under
a range of modelled scenarios (including discounting, costs and
cardiovascular disease reversal).23
The objective of this study was to identify key opportunities for
reformulation of processed foods that could best decrease population
sodium intakes in NZ.
MethodsIdentification of major food groups contributing to sodium intake in NZ
Major food groups contributing to sodium intakes in NZ were
identified through a review of relevant national literature and
reports, including: an analysis of sodium intakes from the 1997
Adult National Nutrition Survey,3 a survey of salt in processed
foods in NZ,24 and the 2003-04 New Zealand Total Diet Survey.25
Bread, processed meats, and sauces were identified as contributing
>5% to sodium intakes in NZ (26%, 10%, and 6% respectively).
Data collectionA cross-sectional survey of the sodium content of all processed
bread, meats, and sauces was undertaken at the largest supermarket
in Auckland, NZ (Countdown Greenlane). Data were collected over
a one-month period between December 2010 and January 2011. All
data were collected manually onto a standardised collection sheet
from the mandatory Nutrition Information Panel (NIP) present
on the back of most product packages. The following data were
collected for each food product: brand and product name, packet size
(g/mL), and sodium content (mg/100 g or mg/100 mL as reported).
Statistical methods Data were entered into a Microsoft Excel spreadsheet and
uploaded into SPSS Statistics 19 for analysis. A value range check
was completed in Excel to ensure all sodium values appeared
appropriate. Where values were substantially outside of the range
for a particular food category, they were checked using source
documents and amended where necessary. Food products were
categorised into three food groups and 28 minor food categories
using a previously published categorisation system for processed
foods.20
Normality of the data was checked by assessing the distribution
and comparing estimates of central tendency (i.e. mean and
median). Analysis was undertaken to determine average sodium
contents (mean (SD) or median (range) as appropriate) and the
proportion of products meeting 2012 FSA targets. All sodium data
were analysed per 100 g, with the exception of some minor sauce
categories where data were most commonly presented (and thus
analysed) per 100 mL.
Comparison with nutrient targets and sodium values from other countries
There are no nationally agreed sodium targets available for NZ
processed foods. Therefore, the UK FSA sodium reduction targets
were used. The Heart Foundation Project Target 450 value was also
applied for bread because this has been a recognised target for the
Zealand bread industry since 2007.16 Where possible, comparisons
were made between the mean sodium content of breads, processed
meats, and sauces available in NZ with those reported for similar
products in Australia20 and the United Kingdom (UK).19
Opportunities for reformulation were identified where mean
sodium contents were substantially higher than corresponding
2012 UK FSA targets; where sodium values were significantly
higher than those reported for similar foods in Australia and/or the
UK;19,20 where the food category contributed most to sodium intakes
in NZ (using national dietary intake data);6,25,26 and/or where the
food category in question was known to be high-volume (in terms
of sales) in NZ.27
ResultsSodium data were collected for 946 products (n=215 bread, 233
processed meats, and 444 sauces) across 21 minor food categories
(Table 1). Sodium values for breads and processed meats were
normally distributed and thus means (SD) are presented for these
categories. However, the distribution of the sodium content of sauces
was slightly skewed. Therefore, the median (range) is presented
alongside the mean (SD) for this food group. Presentation of both the
mean (SD) and median (range) is to allow for comparison with FSA
targets and mean values from similar products in other countries.
It was possible to compare the United Kingdom FSA targets with
11/21 minor food categories.
Sodium content; comparison with 2012 FSA targets
Breads
The mean (SD) sodium content across all breads was 447 (125)
mg/100 g (Table 1). Across minor categories, the mean (SD) sodium
content ranged from 300 (83) mg/100 g for fruit bread to 504 (169)
mg/100 g for flat bread. There was a wide range of sodium contents
Policy Failure Sodium reduction in NZ processed foods
86 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2012 vol. 36 no. 1© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia
Table 1: Sodium content of three processed food groups in NZ and proportion of products that meet UK FSA targets.Contribution to population sodium intake
(%)a
Food group # products 2010 United Kingdom FSA target (mg/100 g)
2012 United Kingdom FSA target (mg/100 g)
Mean (mg/100 g)
SD (mg/100 g)
Medianc (mg/100g)
Range (mg/100 g)
Products meeting 2012 target (%)
25.7 Bread
White
Wholemeal
Multigrain
Fruit
Flat
Other
215
18
12
52
10
39
84
N/T
430
430
430
430
430
N/T
N/T
400
400
400
400
400
N/T
447
433
414
415
300
504
465
(125)
(98)
(72)
(70)
(83)
(169)
(123)
–
–
–
–
–
–
–
140-900198-630
218-500
186-620
210-490
230-900
140-785
-
33
42
14
90
26
–10.3 Processed meat
Bacon
Sausages/hot dogs
Sliced meat
Salami/cured meat
Meat burgers
23342
68
14
96
13
N/T1,400
550
N/T
1000
400
N/T1150
450
300
800
300
11691093
952
1002
1478
455
(444)(276)
(260)
(255)
(429)
(127)
–
–
–
–
–
–
290-3,700580-1,820
540-1,920
540-1,332.5
754.4-3,700
290-740
–
60
0
0
2
156.3 Sauces
Table sauces4
Tomato sauce
Chili sauce
Barbecue sauce
Steak/Worcestershire
Asian sauces
Mustard
Marinade
Meat accompaniment
Tomato paste
Meal-based sauces4
Powdered
Ambient
Liquid
Pasta sauce
Gravy
Stock
444
43
10
24
5
4
26
18
6
20
17
189
22
143
24
70
31
24
N/T
N/TN/T
1,000
N/T
600
600
N/T
N/T
N/T
N/T
1,200
N/T
N/A
430
430
430
N/T
N/T
N/TN/TN/T
730
N/T
600
600
N/T
N/T
N/T
N/T
600
N/T
N/A
330
330
330
N/T
N/T
1,0461,642
–
765
1,5492
813
907
5,141b
1,779
2,772b
361
765
–
352b
1,444
1,112
460
484b
340b
(1,235)(2043)
–
(269)
(522b)
(224)
(326)
(1,941b)
(1,012)
(1,171b)
(586)
(269)
–
(130b)
(1,599)
(531)
(113)
(107b)
(109b)
561540b
–
793
1,495b
813
851
5,603b
1613
2,199b
180
265
–
312b
726
1,151
440
455b
319b
9-9,549119-8,000–
170-1,080
620-2,7302
477-1,090
582-1,346
584-8,0002
55-4,895
1682-4,408b
9-2,300
22-975
–
119-630b
169-9,549
165-2,430
230-725
310-768b
196-570b
–
–
–
30
–
20
25
–
–
–
–
82
–
–
11
4.2
10
–
–Notes:a Additional analyses of the 1997 New Zealand National Nutrition Survey26
b mg/100 mL productc Median displayed in addition to mean for sauces due to skewed distribution of results in this food groupd Totals for category not calculated as subcategories within the category contain sodium values in both mg Na/100 g and mg Na/100 mL, which could not be
combinedN/T – No United Kingdom Food Standards Agency target matching our description of this food group/categoryN/A –United Kingdom Food Standards Agency target matching the description of this food sub-category is set in different units to the data presented in the table
and is consequently not applicable.
for individual products within minor bread categories, particularly
for the flat bread category (range = 230-900 mg/100 g). With the
exception of fruit bread, the mean sodium content of all minor food
categories of bread exceeded the corresponding 2012 FSA target
(where comparable). Nonetheless, there were a number of products
in each category that met FSA targets. The percentage of products
meeting the corresponding FSA target ranged from 90% for fruit
breads to 14% for multigrain breads, but was <50% for all other
minor food categories. Nonetheless, when compared with the Heart
Foundation Project Target 450 value, substantially more breads met
the sodium target, particularly for multigrain, white, and wholemeal
categories (91%, 83% and 83%, respectively). This suggests that
a large number of NZ breads have sodium levels between 400 and
450 mg/100 g.
Processed meatsThe mean (SD) sodium content across all processed meats was
1,169 (444) mg/100 g (Table 1). Across minor categories, mean
(SD) sodium content ranged from 1,478 (429) mg/100 g for salami
and cured meats to 454 mg/100 g (127) mg/100 g for meat burgers.
Similar to bread, the range of sodium contents for individual
products within each minor category was wide, particularly for
the salami and cured meats category (754-3,700 mg/100 g) and
the sausages and hot dogs category (540-1,920 mg/100 g). For
two minor categories (sausages and hot dogs; and sliced meat), no
products met the corresponding FSA 2012 sodium target, and in one
minor category (salami and cured meats) only 2% of products met
the FSA target (Table 1). Bacon was the only minor food category
Woodward, Eyles and Mhurchu Article
2012 vol. 36 no. 1 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 87© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia
where the mean sodium content was less than the corresponding
FSA 2012 target (mean (SD) = 1,169 (444) mg/100 g compared
with ≤1,400 mg/100 g, respectively).
SaucesThe mean (SD) sodium content across all sauces where data were
collected per 100 g was 1,046 (1,235) mg/100 g, and per 100 mL
was 1,642 (2,043) mg/100 mL (Table 1). Across minor categories,
the mean (SD) sodium content ranged from 5,141 (1941) mg/100mL
for Asian sauces to 361 (586) mg/100 g for meat accompaniments.
Within minor categories of sauces the range of sodium contents for
individual products was wide, particularly for the ambient meal-
based sauces category (69 to 9,549 mg/100 g). The mean sodium
content of all minor categories of sauces exceeded 2012 FSA targets
(where comparable), with the percentage of products meeting
targets ranging from 82% for tomato pastes to just 4% for liquid
meal-based sauces (the percentage for all other minor categories
was <50%; Table 1).
Comparison with the UK and AustraliaFor breads and sauces, the mean sodium content of NZ products
was higher than for similar products in the United Kingdom, yet
lower than for similar products in Australia. For processed meats,
the mean sodium content of NZ products was higher than for similar
products in both Australia and the United Kingdom. Overall, the
United Kingdom reported the lowest sodium content of all three
processed food groups, and Australia reported the highest (Figure 1).
Best opportunities for reformulationBread is the highest contributor to sodium intakes in NZ (~26%);
the mean sodium content of the following minor bread categories did not meet the corresponding maximum FSA target: white bread (33 mg/100 g above target), wholemeal bread (14 mg/100 g above target), multigrain bread (15 mg/100 g above target), and flat bread (104 mg/100 g above target). Although flat breads had a mean
sodium level far in excess of the FSA target, white bread is the most commonly consumed bread in NZ.27,28 Therefore, white bread was identified as a key area for sodium reduction.
For processed meats (the second highest contributor to sodium intake in NZ at ~10%), the mean for the following minor food categories did not meet the FSA target: sausages/hot dogs (502 mg/100 g above target), sliced meat (702 mg/100 g above target), salami and cured meat (678 mg/100 g above target), and meat burgers (154 mg/100 g above target). Sausages are a common processed meat product in NZ27,28 and generally provide a relatively cheap meat option for low-income families. Therefore, the salami/cured meat and sausages/hot dogs categories were identified as key areas for healthier sodium reformulation.
For sauces (the third highest contributor to sodium intake in NZ at ~6%), the mean for the following minor food categories did not meet the maximum FSA target: tomato sauce (35 mg/100 g above target), barbecue sauce (213 mg/100 g above target), steak/Worcestershire sauce (307 mg/100 g above target), tomato paste (165 mg/100 g above target), ambient meal-based sauces (1,114 mg/100 g above target), liquid meal-based sauces (782 mg/100 g above target), and pasta sauce (130 mg/100 g above target). Although the sodium content of many NZ sauces was found to be high, this food group was not considered a primary priority area for sodium reformulation due to the lower contribution to population sodium intakes (6%)26 and the mixed results of this food group (i.e. some sauce sub-categories had average sodium contents that met FSA targets, whereas others did not; Table 1).
DiscussionThis study found substantial scope for the reformulation of major
processed foods with a view to reducing sodium intakes in NZ. The
mean sodium content of most breads, processed meats, and sauces
exceeded corresponding UK FSA 2012 targets, and was higher than
for similar products in the United Kingdom. Three key opportunities
for sodium reduction were identified that if achieved would be likely
to lead to substantial positive public health gains in NZ. These were:
sausages/hot dogs, salami/cured meats, and white bread.
A key strength of this study is that sodium data were collected
directly from product labels in a large supermarket. Therefore, the
findings present an up-to-date picture of the sodium content of key
processed food products making substantial contributions to New
Zealanders sodium intakes. Although data were only collected from
one supermarket, it was the largest store in Auckland with the widest
product range. Furthermore, if data collection had been extended to
include more supermarkets it is unlikely that overall mean values
or findings would substantially change.20
A potential weakness of the study is that sodium composition
data recorded from the NIPs of processed foods may not be accurate
(in NZ there is no requirement for the chemical analysis of food
products).29 No studies have been undertaken comparing the
sodium content of NZ NIP data with chemical analysis. However,
a study of 60 lunch foods in the United States comparing calculated
sodium values with those obtained from chemical analysis suggests
calculated sodium values may overestimate actual sodium contents.30
Policy Failure Sodium reduction in NZ processed foods
Figure 1: Mean sodium content of New Zealand processed foods compared with similar products in Australia and the United Kingdom.
1800
1600
1400
1200
1000
800
600
400
200
0Bread Meat Sauces
Processed food group
447531
397
1169
912
590
1046
1587
1286
New Zealand (g) Australia (g) United Kingdom (g)
Sodi
um c
onte
nt (m
g pe
r 100
g/m
l)
88 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2012 vol. 36 no. 1© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia
Nonetheless, any inaccuracies in the sodium values collected from
NIPs collected for this study are likely to be random and thus
unlikely to effect the conclusions arising from the current analysis.
Another potential limitation of this study is the lack of weighted
sales data. Such data would have enabled calculation of sales-
weighted means for various food groups, similar to those reported
in the United Kingdom.19 Weighted means provide a better
indication of the contribution particular products make to overall
sodium intakes. However, as such data must usually be purchased
at significant cost from food manufacturers or market research
companies, they were not feasible for this study. Nonetheless, as
this study focused on the top contributors to sodium intake in NZ
based on national intake data, the findings are still highly relevant.
Of the food groups assessed in this study, bread had the largest
percentage of products meeting FSA targets (range across categories
= 14-90%). Although the FSA sodium target is more stringent
than the Project Target 450 value (by 50 mg/100 g), this finding
likely reflects work undertaken by food manufacturers through
the Heart Foundation initiative. Because this initiative has recently
been expanded to other categories of NZ processed foods (through
HeartSAFE16), future analysis of the sodium content of processed
meats and sauces may find more products meeting targets. The lower
mean sodium values reported for most bread, processed meat and
sauce categories in the UK are likely reflective of food reformulation
efforts in response to the national sodium targets which have been
in place since 2007.10
The study findings provide a context for further reformulation to reduce the sodium content of NZ foods, and could inform the setting of NZ-specific sodium reduction targets for food manufacturers. Although important work has been initiated by the Heart Foundation of NZ (particularly for bread), similar efforts must be undertaken across the board in all categories of processed foods in order to make substantial improvements to population sodium intakes. Furthermore, as white breads have been identified as an area for further reformulation, and the Heart Foundation target of 450 mg/100 g has not been changed since 2007, consideration should now be given as to whether this target needs to be reassessed. Finally, with the increasing popularity of fast food and food consumed away from the home31,32 sodium-reduction strategies should also be considered for foods sold at restaurants, cafes, and other food service outlets.
The findings indicate three priority areas for sodium reformulation where initial widespread efforts may best be focused. However, as sodium plays a range of roles in processed foods, including preservation, flavour and processability,33 sodium reduction in some food categories may be easier than others. Over the long-term, a broader sodium reduction program encompassing a wide range of processed food products should be considered in order to optimise gains in population health. Nonetheless, large variability was observed in the sodium content of the products assessed in this research suggesting that sodium reformulation is likely feasible across many categories of processed foods. Furthermore, both mandatory and voluntary programs to encourage sodium reduction in processed foods are likely to be cost-effective.23
For sodium reformulation to be most effective, further data on the sodium content of products in other processed food groups is required. In conjunction with up-to-date information on sodium intake, such data could be used to set appropriate country-specific sodium reduction targets for food manufacturers in NZ, and a national sodium reduction strategy. Monitoring of the food supply in response to such targets (and other sodium reformulation initiatives) is also imperative, as is empirical assessment of whether changes in the food supply translate to improvements in diets, health, and
the burden of disease in NZ.
AcknowledgementsEW was supported by a University of Auckland summer
studentship. HE holds a Heart Foundation of New Zealand research
fellowship (grant # 1463). CNM holds the Heart Foundation of New
Zealand Senior Fellowship (grant # 1380).
References1. He F, MacGregor GA. Effect of modest modest salt reduction on blood pressure:
a meta-analysis of randomized trials. Implications for public health. J Hum Hypertens. 2004;16:761-70.
2. Vasan RS, Larson MG, Leip EP, Evans JC, O’Donnell CJ, Kannel WB, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med. 2001;345:1291-7.
3. Stefanogiannis N, Lawes CM, Turley M, Tobias M, Vander Hoorn S, Ni Mhurchu C, et al. Nutrition and the burden of disease in New Zealand: 1997-2011. Public Health Nutr. 2004;8(4):395-401.
4. Scott HM, White HD, Scott WG. Coronary heart disease in New Zealand: an economic study. N Z Med J. 1993;962:347-9.
5. New Zealand Health Strategy. DHB Toolkit: Cardiovascular Disease. Wellington (NZ): Ministry of Health, Government of New Zealand; 2003.
6. Thomson CD, Colls AJ. Twenty-four Hour Urinary Sodium Excretion in Seven Hundred Residents of Otago and Waikato [report]. Wellington (NZ): Ministry of Health, Government of New Zealand; 1998.
7. National Health and Medical Research Council. Nutrient Reference Values for Australian and New Zealand: Including Recommended Dietary Intakes. Canberra (AUST): Commonwealth Department of Health and Ageing; 2006.
8. Brown IJ, Tzooulaki I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. Int J Epidmiol. 2009;38:791-813.
9. Webster J, Dunford E, Hawkes C, Neal B. Salt reduction initiatives around the world. J Human Hypertens. 2011;29(6):1043-50.
10. Food Standards Agency. Salt Reduction Targets 2010 and 2012 [Internet]. Ontario (CAN): Center for Science in the Public Interest; 2010 [cited 2011 Jun 3]. Available from: http://cspinet.org/canada/pdf/uk-fsa.saltreductiontargets.2010_2012.pdf
11. Department of Health and Ageing. Nutrition and Healthy Eating: Food and Health Dialogue [Internet]. Canberra (AUST): Commonwealth of Australia; 2011 [cited 2011 Jun 7]. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/food-health-dialogue
12. Australian World Action on Salt and Health. Drop the Salt. Interim Australian Targets for Sodium Levels in 85 Food Categories: Challenging yet Feasible [Internet]. Sydney (AUST): The George Institute for Global Health, University of Sydney; 2011 [cited 2011 Jun 3]. Available from: http://www.awash.org.au/documents/Interim_Salt_Targets_for_Australia.pdf
13. Health Canada. Stakeholder Consultation on Setting Sodium Reduction Targets (January 2011) [Internet]. Ontario (CAN): Health Canada; 2011 [cited 2011 Apr 29]. Available from: http://www.hc-sc.gc.ca/fn-an/consult/2011-sodium/consultation-eng.php
14. New York City Department of Health and Mental Hygiene. National Salt Reduction Initiative. In: Cutting Salt, Improving Health [Internet]. New York (NY): City of New York; 2011 [cited 2011 Apr 29]. Available from: http://www.nyc.gov/html/doh/html/cardio/cardio-salt-initiative.shtml
15. Dunford E, Eyles H, Ni Mhurchu C, Webster J, Neal B. Changes in the sodium content of bread in Australia and New Zealand from 2007 to 2010: implications for policy. Med J Aust. 2011;195(6):346-9.
16. The Heart Foundation. Approaches to Reducing Sodium. In: Reducing Our Sodium Footprint. HeartSAFE Situation Analysis [Internet]. Auckland (NZ): Project HeartSAFE Group; 2010 [cited 2011 Feb 8]. Available from: http://www.heartfoundation.org.nz/index.asp?pageID=2145881547
Woodward, Eyles and Mhurchu Article
2012 vol. 36 no. 1 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 89© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia
17. Williams P, McMahon A, Boustead R. A case study of sodium reduction in breakfast cereals and the impact of the Pick the Tick food information program in Australia. Health Promot Int. 2003;18(1):51-6.
18. Young L, Swinburn B. Impact of the Pick the Tick food information programme on the salt content of food in New Zealand. Health Promot Int. 2002;17(1):13-9.
19. Ni Mhurchu C, Capelin C, Dunford EK, Webster JL, Neal BC, Jebb SA. Sodium content of processed foods in the United Kingdom: analysis of 44,000 foods purchased by 21,000 households. Am J Clin Nutr. 2010;93(3):594-600.
20. Webster JL, Dunford EK, Neal BC. A systematic survey of the sodium contents of processed foods. Am J Clin Nutr. 2010;91(2):413-20.
21. Dunford E, Webster J, Blanco Metzler A, Czernichow S, Ni Mhurchu C, Wolrans P et al. International collaborative project to compare and monitor the nutritional composition of processed foods. Eur J Cardio Prev & Rehab. 2011 Oct 4 (epub ahead of print). Doi: 10.1177/1741826711425777.
22. Zarocostas J. WHO lists ‘best buys’ for cutting deaths from non-communicable disease. BMJ. 2011;342:d2648. doi: 10.1136/bmj.d2648.
23. Cobiac LJ, Vos T, Veerman JL. Cost-effectiveness of interventions to reduce dietary salt intake. BMJ. 2010;96(23):1920-5.
24. Thomson BM. Survey of Salt in Processed Foods. Wellington (NZ): New Zealand Food Safety Authority; 2006.
25. Vannoort RW, Thomson BM. 2003-04 New Zealand Total Diet Survey. Wellington (NZ): New Zealand Food Safety Authority; 2005.
26. Thomson BM. Nutritional modelling: distributions of salt intake from processed foods in New Zealand. Br J Nutr. 2009;102(5):757-65.
27. Hamilton S, Ni Mhurchu C, Priest P. Food and nutrient availability in New Zealand: An analysis of supermarket sales data. Public Health Nutr. 2007;10(12):1448-55.
28. The Ministry of Health. NZ Food, NZ People. Key Results of the 1997 National Nutrition Survey. Wellington (NZ): Government of New Zealand; 1999.
29. Food Standards Australia and New Zealand. Australia New Zealand Food Standards Codes [Internet]. Wellington (NZ): FSANZ; 2011 [cited 2012 Jan 11]. Available from: http://www.foodstandards.gov.au/foodstandards/foodstandardscode.cfm
30. Obarzanek E, Reed DB, Bigelow C, Glovsky E, Pobocik R, Nicklas T, et al. Fat and sodium content of school lunch foods: calculated values and chemical analysis. Int J Food Sci Nutr. 1993;44:155-65.
31. Statistics New Zealand. Household Economic Survey Year Ended 30 June 2007. Expenditure Classification, 2007. Wellington. Statistics New Zealand [cited 2012 Jan 11]. Available from: http://www.stats.govt.nz/browse_for_stats/people_and_communities/Households/household-economic-survey-info-releases.aspx
32. Statistics New Zealand. Household Economic Survey Year Ended 30 June 2010. Expenditure Classification, 2010. Wellington. Statistics New Zealand [cited 2012 Jan 11]. Available from: http://www.stats.govt.nz/browse_for_stats/people_and_communities/Households/household-economic-survey-info-releases.aspx
33. Kilcast D, Ridder CD. Sensory issues in reducing salt in food products. In: Kilcast D, Ridder CD, editors. Reducing Salt in Foods: Practical Strategies. Cambridge (UK): Woodhead Publishing; 2007. p. 201-20.
Policy Failure Sodium reduction in NZ processed foods
Recommended