1Ontario Tech University, Oshawa, Canada, 2University of Toronto, Toronto, Canada, 3Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud, Tres Rios, Costa Rica, 4Pan American Health Organization, Washington, United States.
Background and objective: Food reformulation is a World Health Organization “best buy” intervention for supporting population-wide dietary sodium reduction, with the establishment of sodium reduction targets for foods as a key implementation strategy. In 2015 the Pan-American Health Organization (PAHO) led the development of regional sodium targets for the Americas, with planned, periodic monitoring and updating. Here, we describe the methodology for updating the PAHO Regional sodium targets that were released in 2021. Methods: Five successive stages were executed to update the targets: 1) Compile national targets set by Member States in the Region; 2) Synthesize and evaluate data on the sodium content of foods in Member States; 3) Consult with countries on the inclusion of new and/or revised food categories; 4) Draft new and/or revised regional targets considering the distribution of sodium in regional foods and best practices in target setting in other jurisdictions, and; 5) Seek feedback and endorsement from the PAHO Technical Advisory Group (TAG) on Cardiovascular Disease Prevention through Population-wide Salt Reduction through a series of meetings. Results: The updated targets were expanded from 18 food categories in 2015 to 75 sub-categories (in 16 food categories). Target levels for 2022 and 2025 were established for all sub-categories (mg sodium/100g and mg sodium/100kcal). The 2022 and 2025 targets were based on a 15% and 30% reduction, respectively, from the measured sodium levels at the 50th percentile. The calculated targets were assessed for feasibility and adjusted by comparing the calculated values to national targets in the region, to the United Kingdom targets, and to the 25th percentile which gave an indication of the overall distribution of sodium in a subcategory. Feasibility assessment also included the known proportion of regional foods meeting the 2015 PAHO sodium targets. Conclusions: The updated PAHO regional sodium targets are feasible and based on regional sodium data and best practices in target setting. The PAHO TAG reached consensus and endorsed the targets. The targets will support countries in the Americas in facilitating food reformulation, towards the achievement of population-wide sodium reduction goals.
Keywords: sodium, policy, sodium reduction targets, public health intervention.