Table 1 Health impact and health economic modeling studies of population-level dietary salt reduction interventions involving reductions in sodium in processed foods (for publications from 1 January 2010 up to the end of June 2015 and ordered by publication year)

Australia, Cobiac et al 2010 [47]

Voluntary and mandatory reduction of salt content in breads, margarine, and cereals.

Both were cost-saving interventions but health gain was much greater for the mandatory vs voluntary intervention (e.g., 110,000 vs 5300 disability-adjusted life-years [DALYs] averted).

US, Smith-Spangler et al 2010 [48]

Voluntary collaboration with industry was assumed to decrease sodium intake by the same amount as reported for the UK (9.5 %), with a range of 5 to 40 %.

Large health gain of 2.1 million QALYs, and savings in medical costs of $US32.1 billion (both over the cohort’s lifetime). Large benefits were seen with a salt tax.

Argentina, Rubinstein et al 2010 [49]

Voluntary reduction of salt content in bread by 1 g salt per 100 g.

Relatively small averted DALYs (compared to other CVD interventions) but still a cost-saving intervention. An earlier result by this team identified this intervention as cost-effective at ARS$151 (US$28) per DALY averted [50].

South Africa, Bertram et al 2012 [51]

Regulations to reduce the sodium content of bread, soup mix, seasoning and margarine (a reduction in salt of 0.85 g/person/day).

Substantial reduction in CVD deaths and non-fatal strokes estimated. Cost savings “of up to R300 million would also occur” (US$128 million).

Australia, Cobiac et al 2012 [52]

Mandatory reduction of salt content in breads, margarine, and cereals.

Large number of DALYs averted per year (80,000) and cost-saving. (See also a similar study listed above by these authors).

Argentina, Konfino et al 2013 [53]

Voluntary initiative currently in place in Argentina for 5 to 15 % reductions of sodium in: (i) processed meats, (ii) cheese and dairy products, (iii) soups and dressings and (iv) cereals, cookies, pizza and pasta.

Large reductions in: all-cause mortality, myocardial infarctions, and strokes, especially if the 2 year program agreed to with industry was extended to a larger 10 year one. (But no cost data included).

Netherlands, Hendriksen et al 2014 [54]

Theoretical reduction in salt in processed foods (variable by food category – but averaging 50 % reduction).

The median salt intake was expected to decrease by 28 % and blood pressure by 1.2 %. An estimated 256,000 DALYs were averted (239,700 to 272,300) and 0.15 per capita life years gained (0.11–0.19) among 40 year olds over the rest of their lifetimes.

New Zealand, Nghiem et al 2015 [4]

Mandatory 25 % reduction of salt in bread, processed meats and sauces. Also a voluntary endorsement label program (covering heart healthy foods [55]).

The gain was larger in the mandatory intervention (62,000 quality-adjusted life-years [QALYs]) vs the current voluntary endorsement label program (8000 QALYs). The interventions were pro-equity with relatively greater health gain for indigenous people (Māori).

USA, Choi et al 2015 [38]

Expansion of the National Salt Reduction Initiative to ensure all restaurants and manufacturers reach agreed upon sodium targets. These cut sodium in 62 categories of packaged, and 25 categories of restaurant, food items.

This expansion “would be expected to avert from 0.9 to 3.0 MIs [myocardial infarctions] (a 1.6–5.4 % reduction) and 0.5 to 2.8 strokes (a 1.1–6.2 % reduction) per 10,000 Americans per year over the next decade.” Most of the benefit came from changes in packaged foods. Also that “even high levels of consumer addition of table salt or substitution among food categories would be unlikely to neutralize this benefit”. The intervention was not found to reduce ethnic inequalities. No cost data were included.

England, Gillespie et al 2015 [56]

Mandatory reductions in all processed foods (10 % and 30 %). Voluntary reformation (24 %) – based on expert panel.

By the year 2025, maximum life-years gained by the mandatory reductions: at 43,900 for the 30 % and 14,800 for the 10 % levels. For voluntary: 14,300 life-years gained. The benefit in reducing health inequalities was greater for the mandatory than the voluntary interventions (when considering absolute differences in life-years).