For our first blog post, we turn to Brazil! Brazil set up a salt reduction programme in 2007 which has had a successful decade, due largely in part to the cooperation of the Brazilian food industry.
Why is salt reduction needed in Brazil?
The Brazilian Household Budget Survey 2008-20091 found that, on average, Brazilian adults consume a shocking 12g of salt per day, more than double the World Health
Organisation (WHO) recommendation of 5g per day2. As we know, a high salt diet raises our blood pressure, which greatly increases our likelihood of developing coronary heart disease (CHD) and having a stroke3. It is perhaps unsurprising then, in light of the high salt intake in Brazil, that high blood pressure affects almost a third (28.7%) of the population and CHD and strokes are the main and third cause, respectively, of premature deaths (deaths in those aged under 70) in the country4.
The main source of salt in the Brazilian diet is salt and salt-based condiments added to meals at the table, which make up more than three quarters (76%) of daily salt intake1. This contrasts with developed countries like the United Kingdom and Australia where three quarters of daily intake comes from salt already present in foods, i.e. that which is added by manufacturers during processing. However, in recent years there has been a shift in eating habits in Brazil more representative of a western lifestyle, with people beginning to rely more on processed foods and foods eaten out of the home as opposed to fresh foods and meals prepared and cooked at home1. Data from Household Budget Surveys from the 1970’s to the mid-2000’s suggest that purchases of processed foods, including cookies, processed meats and ready meals, have increased by up to 400% whilst purchases of more traditional foods have declined5.
Brazil’s salt reduction plan
Since 2007 Brazil’s Ministry of Health has been working with the ABIA (Brazilian Association of Food Industries), who make over 70% of all processed food in Brazil, to improve the nutritional profile of food. The main focus was initially a reduction of trans-fatty acids but, following the results of the Household Budget Survey in 2009, salt reduction was made a priority by the Brazilian government for reformulation work6.
In 2010 the ABIA committed to lowering the sodium content of processed food over 10 years and a baseline assessment was undertaken to determine the average salt content of different food categories. Following this, in April 2011, the first voluntary sodium reduction targets were set for processed foods that contribute the most salt (90%) to the Brazilian population, paying particular attention to the foods that feature most in the diets of children and adolescents7. The categories are:
- Salt-based condiments
- Dairy products, including cheese
- Cookies and biscuits
- Processed meat products, including hotdogs and hams
- Instant pasta
- Cakes, both ready-made and cake mixes
- Snack foods, including potato chips
- Ready meals, including pizza and soup
In addition to reducing the salt content of processed foods, the Brazilian government aims to reduce the excessive population salt intake from 12g to 5g per day by 2020 through promotion of healthy eating and increased supply of healthy foods, formulating guidelines for nutritional labelling of food and education for consumers, industry and health professionals7.
What are Brazil’s salt targets?
Please click here to view Brazil’s salt targets, plus a comparison to the Pan American Health Organisation (PAHO)’s regional targets and the UK targets (where a comparable food category was available). PAHO has long supported salt reduction efforts in the Americas and proposed regional targets, based on the national targets set in Argentina, Brazil, Canada, Chile and the USA. The regional targets have a maximum level plus a more stringent target, based on the lowest targets in the region8.
The table shows that the targets are similar for most Brazilian and UK product categories but the largest differences appear for meat products – the Brazilian target for hamburgers is 2.1 times higher than in the UK (1.85g per 100g v 0.88g per 100g) and the target for ham is 1.8 times higher than the UK (2.9g/100g v 1.63g/100g). Few products have a lower target in Brazil than the UK, but include filled cookies (0.66g/100g v 0.95g/100g) and cheese spread (1.35g/100g v 1.8g/100g). Although this is a good start, the UK’s salt reduction targets are due to be reset at more stringent levels at the end of 2017 and therefore much more work will need to be done to bring salt levels in these foods in Brazil down to levels found in UK foods.
Are Brazilian manufacturers meeting the targets?
An evaluation of products found that 94.9% of instant pasta brands, 97.7% of bread brands and 10% of bun brands have achieved the first sodium targets and that the average sodium content of these categories has been reduced by 10%-15% from 2011 to 20147. A separate evaluation found that in over half of the food categories there was an 8-34% reduction in salt content9. This is excellent progress and clearly demonstrates how successful the salt reduction targets have been in driving reformulation work in the country, proving that producing foods with less salt is possible.
What’s more, the targets are monitored by the Ministry of Health of Brazil, who publish their reports every two years and release the data to the media. This is key in incentivising the food industry to continue with their reformulation work, as transparent monitoring means they cannot hide away. Based on these reports, further meetings are held to evaluate whether the targets can be reset to lower levels for continued progress.
Overall, the salt reduction targets set in Brazil seem to have been successful, and reformulation work in the country will continue until 2020 to ensure that they are met. However, as the main source of salt in the Brazilian diet is discretionary salt, the public education component of the salt reduction plan is much more vital at this stage to ensure that salt intake in the country is lowered to meet the WHO recommended level of 5g/day. Health and nutrition are heavily incorporated into school curriculums and the Ministry of Health runs regular healthy eating campaigns, with salt reduction as a central focus. Furthermore strict standards are in place for food served in cafeterias, both in schools and industry workplaces8.
Unfortunately, there has not been another population wide salt intake analysis since the 2008-2009 Household Budget Survey and therefore it is not yet possible to determine the success of the salt reduction programme in relation to population salt intake. However, a small scale study conducted in Vitória, a city in Southeast Brazil, found that salt intake in a sample of 272 adults was 10.4g/day, which represents a 13% reduction from the national average intake in 2008-2009 and suggests some improvements have been made 10.
By closely monitoring products and regularly publishing results, the Ministry of Health and the Brazilian food industry have managed to achieve continuous salt reduction, setting an excellent example for the UK and many other countries around the world where salt reduction initiatives have lost momentum.
A special thanks to Eduardo Nilson, Ministry of Health of Brazil
- Brazilian Institute of Geography and Statistics (2011). Pesquisa de Orcamentos Familiares 2008-2009 (in Portugese). Available online: http://biblioteca.ibge.gov.br/visualizacao/livros/liv50063.pdf (last accessed 26/09/2017)
- World Health Organisation (2012). Guideline: Sodium intake for adults and children. Available online: http://apps.who.int/iris/bitstream/10665/77985/1/9789241504836_eng.pdf (last accessed 26/09/2017)
- MacMahon, S. et al. (1990) Blood pressure, stroke and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet, Mar 31;335(8692):765-74
- Ministry of Health of Brazil (2015). Saúde Brasil 2014: Uma análise da situação de saúde e das causas externas (in Portugese). Available online: http://bvsms.saude.gov.br/bvs/publicacoes/saude_brasil_2014_analise_situacao.pdf (last accessed 26/09/2017)
- Schmidt, M.I., et al. (2011). Chronic non-communicable diseases in Brazil: burden and current challenges. Lancet, Jun 4;377(9781):1949-61
- Nilson, E.A.F., et al. (2012). Initiatives developed in Brazil to reduce sodium content of processed foods. Rev Panam Salud Publica, Oct;32(4):287-92
- Nilson, E.A.F. (2015). The strides to reduce salt intake in Brazil: have we done enough? Cardiovasc Diagn Ther, Jun; 5(3): 243-247
- Pan American Health Organisation (2015). Regional Targets on Salt Reduction. URL: http://www.paho.org/hq/index.php?option=com_content&view=article&id=10399%3Aregional-targets-salt-reduction&catid=7587%3Ageneral&Itemid=41253&lang=en (last accessed 26/09/2017)
- Nilson, E.A.F., et al. (2017). Sodium reduction in processed foods in Brazil: Analysis of food categories and voluntary targets from 2011 to 2017. Nutrients, Jul 12;9(7). Pii:E742
- Rodrigues, S.L. et al. (2015). Relationship between salt consumption measured by 24-h urine collection and blood pressure in the adult population of Vitoria (Brazil). Braz J Med Biol Res, Aug;48(8):728-35