Eleanore Alexander,1 Derek Yach,1 George A. Mensah,2 Gregory L. Yep3
1. Global Health and Agriculture Policy, PepsiCo, Inc., Purchase, NY, USA.
2. Global Nutrition, Global Research and Development, PepsiCo, Inc., Purchase, NY, USA.
3. Long Term Research, Global Research and Development, PepsiCo, Inc., Purchase, NY, USA.
Salt Reduction is a Global Need
The importance of reducing salt intake gained international prominence in 2011 during the UN High Level Meeting on Non-Communicable Diseases (HLM). Excess salt intake is strongly linked to increased blood pressure, and raised blood pressure is a cause of cardiovascular disease, one of the four NCDs (in addition to diabetes, cancer, and chronic lung disease) highlighted at the HLM. NCDs caused 63% of global deaths in 2008 and are projected to increase 15% from 2010 to 2020.1 Salt reduction was listed by the Lancet as a “best buy‚“ for NCD prevention, second only to tobacco control.2 Governments have called upon the food industry to reduce salt use in order to lower sodium consumption. Due to high prevalence of excessive salt intake, the food sources providing salt in the diet need to be investigated to appropriately inform policy. The INTERSALT study highlighted the range of sodium intake from 18.4 mg/day in male Yanomamo Indians of Brazil to 5,957 mg/day in males in Tianjin, China.3 Mean sodium intake in the US is 3,266 mg/day.4 The WHO has recommended lowering sodium intake to less than 2,000mg/day as a cost-effective method to reduce blood pressure.5
Sources of Sodium in the Diet
Processed foods provide the majority of sodium in the diet in Europe and the US, while sodium often comes from sauces and salt added at the table in Asian and African countries.6 The top five food categories contribute over 25% of sodium intake in US adults and include breads, cold cuts, pizza, poultry and soups.4 Recent data from South Africa shows that bread contributes more than 50% of sodium intake in some population groups.7 Soy sauce contrib
utes 20% of sodium intake in Japan, and 76% of sodium intake in China is from salt added during home cooking or at the table.3
Global Data Needs
Data for food sources of sodium intake are not available for most countries; currently, packaged food sales data offers the closest comprehensive data to investigate leading dietary sources of sodium intake on a global scale. According to Euromonitor data, the top packaged food manufacturers in a country are often local small and medium enterprises (SMEs) rather than large multinationals (MNCs).8 MNCs ranking in the top ten often account for less than 10% of national packaged food sales in developing countries. This does not include the informal sector (non-taxed sales). It is estimated that 2.5 billion people eat foods purchased through the informal sector daily, so the importance of understanding the contribution of the informal sector, in addition to SMEs and MNC
s, to dietary sodium intake in countries is imperative.9
Elements Needed for Successful Sodium Reduction
High income countries including the UK, Japan and Finland have achieved success in reducing sodium intake through public health education campaigns, industry reduction of salt in packaged foods, and product labeling legislation; these interventions achieved success due to collaboration between government, NGOs, consumers, the media, and industry.10 New York City is leading the US National Salt Reduction Initiative (NSRI) with the goal of reducing Americans’ salt intake by 20% over five years by partnering with packaged food companies and restaurants to reduce sodium levels in products.11 High income countries tackling salt reduction have several attributes that support success: strong regulatory capacity, majority of food sales through the formal sector, public knowledge of the health risks of sodium intake, and strong states with enforcement capabilities.10 Low and middle-income countries likely do not have the same regulatory capacity and consumer knowledge.
PepsiCo Actions to Reduce Sodium
Reducing sodium intake will require consumer demand for reduced sodium products in addition to action from governments, the media, and industry. PepsiCo has pledged to reduce sodium by 25% in key global food brands in key markets by 2015 (with a 2006 baseline), and has successfully reduced sodium in products in many countries without compromising product taste.12 Much of this reduction is stealth‚ and not directly communicated to the public to prevent consumers from rejecting the product based on preconceptions of poor taste. In the U.K., Walkers has significantly reduced sodium in its products since 2005. In 2011, Frito-Lay in the U.S. reduced sodium by nearly 25%, on average, across its entire flavored potato chip portfolio. In Canada, Quaker instant oats products have been reformulated with a 15% to 25% reduction in salt. In Brazil, sodium was reduced in one of PepsiCo’s most popular snacks, Fandangos, by more than 30%. The public health impact of reducing sodium levels in PepsiCo’s portfolio is limited by the amount of sodium PepsiCo products contribute to the diet.
Reducing Sodium on a Global Scale
Gradually reducing sodium content, while maintaining product taste, is essential to shift consumers to products with lower sodium content. Large companies with significant R&D resources and consumer insight knowledge will benefit from encouraging SMEs to simultaneously reduce sodium content in their products because it provides a level processed food landscape where consumers’ options are all similarly low in sodium. PepsiCo plans to share salt reduction best practices and consumer insights with SMEs in selected developing countries to encourage SMEs to reduce sodium in their products. Through local workshops and ongoing engagement, PepsiCo will engage R&D scientists, consumer insights experts, and ingredient vendors in discussions related to effective salt reduction in a competitive market. The project will pilot in South Africa in 2012, with more locations for country forums announced throughout the year. The pilots aim to provide the resources SMEs need to reduce sodium in locally produced foods, and PepsiCo hopes that the forums will lead to continued and more informed dialogue between the food industry, government and NGOs regarding collaboration to reduce salt consumption.
Conclusion
The scientific evidence linking excess dietary sodium intake and adverse health outcomes is compelling. Similarly, the health benefits of dietary sodium reduction strategies are now proven. Knowing these two facts is, however, not enough. We need effective partnerships between governmental agencies, NGOs, the public health community, consumers, health advocacy groups, the media, and the food and beverage industry to enable successful salt reduction strategies. At PepsiCo, we hope that the forums we have started will lead to continued, informed dialogue between all stakeholders regarding collaboration to reduce salt consumption.
Derek Yach is Senior Vice President of Global Health and Agriculture Policy at PepsiCo where he leads engagement with major international groups and new African initiatives at the nexus of agriculture and nutrition. Derek and his team are focused on long-term strategic thinking and practices, underpinning the business on strong sustainable development principles. The team promotes innovative thinking to identify risk and opportunity to the business and to build Pepsico’s corporate reputation.
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