Health Canada's Approach to Developing Sodium Targets for the Canadian Food Supply (February 2010)
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In Canada, a large majority of Canadians are consuming levels of sodium that put them at risk for high blood pressure. Results from Statistics Canada's 2004 Canadian Community Health Survey 2.2 (CCHS 2.2) show that, among people aged 9 to 70, over 85 percent of men and 60 to 80 percent of women had sodium intakes exceeding the Tolerable Upper Intake Level (UL)1 for sodium. Similar high intakes are seen in young children: 77% of children aged 1 to 3 and 93% of children aged 4 to 8 exceed the UL for sodium.
To address these high intakes, the Government of Canada established the Sodium Working Group2 to develop, implement, and oversee a multi-staged, three-pronged strategy for the reduction of the sodium content of the diets of Canadians. The three prongs of the strategy are education, voluntary reduction of sodium levels in processed food products and foods sold in food service establishments, and research.
Recommended Public Health Goal for Sodium
At their meeting of September 28-29, 2009, the Sodium Working Group agreed to the recommended goal of reducing sodium in the Canadian diet to 2300 mg per person per day by the year 2016. This goal is based on achieving a five per cent reduction per year in the amount of sodium consumed by Canadians, currently estimated at 3400 mg per day, on average. Health Canada is working with stakeholders to help achieve this goal through a number of initiatives including setting sodium targets for foods. The process by which these targets will be set is described below.
Setting targets for sodium content in foods
To develop draft proposed reduction targets for sodium content in food, Health Canada used two starting points: the United Kingdom's Food Standards Agency's (UK FSA) sodium targets for 2012 and data on the sodium contents of food currently in the market place in Canada.
- a) UK FSA - Salt Campaign3
Since 2003, the UK Food Standards Agency (FSA) has had in place a program to help UK consumers reduce their salt intakes. The program has been focused on two main areas: reformulation work (involving all sectors of the food industry) and an ongoing public awareness campaign to inform consumers about sodium reduction.
Health Canada used the FSA's 2012 targets4 , matching the UK food groups as closely as possible with Canadian foods (as reported in the CCHS 2.2), to estimate what the sodium intake of Canadians would be if we used the same targets. The results indicated that the total average per capita sodium reduction would bring the intake of Canadians at, or close to, the Tolerable Upper Intake Levels (2300 mg per day for adults).5 This showed that the UK FSA targets were very useful as a starting point for setting Canadian targets.
- b) Sodium content of foods in Canada
The main contributors of sodium in the diets of Canadians were determined by Health Canada using data from the 2004 CCHS 2.2 on Nutrition6 . Using this information, a first set of food categories (Group I foods) that contribute around 50 to 60% of sodium to the diets of Canadians was determined. The main categories for the Group I foods include: soups, processed meats, bakery products, cereals, dairy products, fats and oils, sauces, fish products, miscellaneous/combined dishes, and snacks.
With these initial food categories, Health Canada used 2007 and 2008 Canadian A.C. Nielsen market volume data to develop a sampling plan. This plan identified the individual products for which Nutrition Facts sodium information would be obtained and used to estimate the average sodium content, range and distribution of sodium levels within each category.7
Another "matching exercise" was done between the UK FSA food categories and commercial Canadian foods in the market place. The UK FSA targets were then compared with the sodium content data of the Canadian counterpart foods (see (b) above) and a decision was made about whether to use the UK FSA targets or a number more appropriate to the Canadian marketplace to select a draft proposed target.
Discussions with Food Industry Stakeholders
In September 2009, Health Canada and the Food Supply Sub-committee of the Sodium Working Group met with food industry stakeholders to inform them about the issue of sodium, and the work of the SWG and to lay the ground work for discussions on sodium reduction targets for processed foods and foods sold through foodservice establishments. Preliminary data from the sodium food label survey were shared and approaches were reviewed that could be used to establish Canadian sodium reduction targets as part of the Department's efforts to reduce the sodium intake of Canadians.
In November and December 2009, Health Canada held a series of meetings with the food industry by sector and with individual companies to present draft proposed sodium content targets and explain how they were derived through the aforementioned process. The objective of these meetings was to begin the process of setting realistic and feasible sodium targets to achieve the public health goal, taking into account the technical feasibility and potential timeframe to implement such reductions. Industry was asked to provide feedback to Health Canada on the proposed targets by April 2010 at the latest.
It is understood that the process of setting targets for sodium content in foods is complex since the role and function of sodium in foods varies depending on the nature of the food.
- Food manufacturers and the food service industry will need to reformulate their food products to include less sodium, which is a challenge as sodium is used as flavouring and as a preservative and antibacterial agent, and has many effects on the texture and structure of foods. Gradual reductions, which are preferable to ensure consumer acceptance, will likely require repeated reformulations over time; and
- Consumers will need to become more aware of sodium in foods so they can make changes to their diet, buy foods that are lower in sodium, and add less salt to their foods. Consumer behaviour change takes time. It will also take time for consumers to adjust taste preference towards less salty foods.
Industry's feedback with respect to the technical aspects and other barriers to achieving the targets, such as consumer awareness and acceptance issues, will be considered in the development of the final proposed sodium targets and the intermediate milestones for the Group I foods. These proposed final targets will be distributed to industry for review prior to being presented to the SWG for endorsement as recommended targets.
Progress towards reaching the overall sodium intake goal of 2300 mg/day, as well as the stepwise sodium reduction targets for foods, will be monitored and revised as needed.
Health Canada will be collecting data on the balance of foods, both prepackaged and foods sold in foodservice establishments (the "Group II" foods), that contribute substantially to sodium intake, and will follow a similar approach for setting targets, beginning in early 2010. Sodium targets for Group II foods are expected to be finalized by end of 2010/early 2011.
The database established during the food label survey will act as a baseline from which progress will be monitored as the targets are adopted.
1 The Tolerable Upper Intake Level (UL) for sodium is set by the Institute of Medicine of the National Academies (IOM). They recommend that people aged 14 and over not exceed 2300 mg of sodium per day.
2 For more information about sodium and the working group visit: www.healthcanada.gc.ca/sodium
4 United Kingdom Food Standards Agency's (UK FSA) 2012 sodium/salt targets http://www.food.gov.uk/healthiereating/salt/saltreduction
5 By applying the UK FSA 2012 targets to the foods, using the targeted average when available - otherwise applying the maximum, the sodium intake of Canadians would be below or close to the UL for sodium, depending on the age-sex group. The total average per capita sodium reduction would be 880 mg/day, equalling a 26% reduction in total intake, or 28% reduction in sodium intake from foods, excluding the salt added by the consumer. It is important to note that, where there was a food that there was no UK FSA target for, other adjustments were made, including in some cases, application of the Heart and Stroke Health Check criteria.
7 The preselected food labels were picked up in various stores across Canada or digitally photographed and delivered to HC for analysis. To increase the number of the sampled foods, additional information was gathered directly through a specific company or through information posted on Internet (verified by the company afterwards). The food labels collection was conducted during the months of July, August and September 2009.
Additional food labels available in Health Canada were also used to extend this first set of food categories. These labels were collected from the Canadian market in March 2008 and in October 2008. Sodium results from these labels are not weighted and will be identified as it is.
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