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Strategies to reduce sodium levels in packaged foods are effective and cost-effective approaches to reducing the burden of disease attributable to high sodium intakes. This review aimed to comprehensively describe, and explore characteristics of, national strategies to reduce sodium levels in packaged foods, and assess progress towards achieving national goals. A secondary aim was to understand the number, type and variation of food category sodium targets set by countries compared with World Health Organization (WHO) global sodium benchmarks. National sodium reduction reformulation strategies were identified from a search of peer-reviewed and grey literature up to December 2019 supplemented by verified information from key contacts and experts up to December 2020. Key characteristics of countries' strategies were extracted, synthesised and descriptively analysed, including details of reformulation strategies and evaluation data. Country targets were mapped to the WHO global sodium benchmarks and the number and variation of country sodium targets by WHO food categories were determined. Sixty-two countries had reformulation strategies to reduce sodium in packaged foods and 19 countries had evaluated their reformulation strategies. Forty-three countries had sodium targets, which varied in type of targets (maximum sodium level: n=26, maximum level plus relative reduction/average/sales-weighted average: n=8, relative reduction: n=7, average: n=2), number of food category targets (range: n=1 to 150) and regulatory approach (voluntary: n=28, mandatory: n=9, both: n=6). Eight of 34 countries mapped to the WHO benchmarks had targets for just one specified food category (bread products). One-third of all countries were implementing national strategies to reduce sodium levels in packaged foods including establishing targets and/or processes for industry engagement. This review determined that there is scope to improve most countries' strategies. There has been limited progress in implementing and evaluating strategies between 2014 and 2019, and regional and income-level disparities persist. The WHO global sodium benchmarks present an important opportunity to accelerate reformulation action globally. © The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.


Emalie Rosewarne, Joseph Alvin Santos, Kathy Trieu, Dejen Tekle, Cliona Ni Mhurchu, Alexandra Jones, Nicole Ide, Rain Yamamoto, Chizuru Nishida, Jacqui Webster. A Global Review of National Strategies to Reduce Sodium Levels in Packaged Foods. Advances in nutrition (Bethesda, Md.). 2022 Apr 29

PMID: 35485741

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