Key opportunities for sodium reduction in New Zealand processed foods

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: [email protected]

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


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


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


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)


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).

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Documents

Key opportunities for sodium reduction in New Zealand processed foods