An Evaluation of the Sodium Content and Compliance with the National Sodium Reduction Targets among Packaged Foods Sold in Costa Rica in 2015 and 2018

Jaritza Vega-Solano, Adriana Blanco-Metzler, Karla Francela Benavides-Aguilar, JoAnne Arcand, Jaritza Vega-Solano, Adriana Blanco-Metzler, Karla Francela Benavides-Aguilar, JoAnne Arcand

Abstract

High blood pressure is a leading cause of death in Costa Rica, with an estimated mortality rate of 30%. The average household sodium intake is two times higher than the World Health Organization recommendation. The consumption of processed foods is an important and growing contributor to sodium intake. The objective of this study was to describe the sodium content of packaged foods (mg/100 g) sold in Costa Rica in 2015 (n = 1158) and 2018 (n = 1016) and to assess their compliance with the national sodium reduction targets. All 6 categories with national targets were analyzed: condiments, cookies and biscuits, bread products, processed meats, bakery products, and sauces. A significant reduction in mean sodium content was found in only 3 of the 19 subcategories (cakes, tomato-based sauces, and tomato paste). No subcategories had statistically significant increases in mean sodium levels, but seasonings for sides/mains, ham, and sausage categories were at least 15% higher in sodium. Compliance with the national sodium targets among all foods increased from 80% in 2015 to 87% in 2018. The results demonstrate that it is feasible to reduce the sodium content in packaged foods in Costa Rica, but more work is needed to continually support a gradual reduction of sodium in packaged foods, including more stringent sodium targets.

Keywords: Costa Rica; Latin America; food industry; food policy; process food; salt; sodium; sodium reduction; sodium targets.

Conflict of interest statement

The authors declare no conflict of interest. The founding sponsor had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Figures

Figure 1
Figure 1
Comparison between years of the compliance with the national target for the sodium reduction in packaged food categories, Costa Rica, 2015–2018.

References

    1. Newberry S.J., Chung M., Anderson C.A.M., Chen C., Fu Z., Tang A., Zhao N., Booth M., Marks J., Hollands S., et al. Sodium and Potassium Intake: Effects on Chronic Disease Outcomes and Risks. RAND Southern California Evidence-based Practice Center; Santa Monica, CA, USA: 2018. pp. 1–951. Comparative Effectiveness.
    1. Aburto N.J., Ziolkovska A., Hooper L., Elliott P., Cappuccio F.P., Meerpohl J.J. Effect of lower sodium intake on health: Systematic review and meta-analyses. BMJ. 2013;346:1326. doi: 10.1136/bmj.f1326.
    1. Organización Mundial de la Salud LAS 10 Principales Causas DE DefuncióN. [(accessed on 3 October 2018)]; Available online:
    1. GBD 2015 Mortality and Causes of Death Collaborators Global, Regional, and National Life Expectancy, All-Cause Mortality, and Cause-Specific Mortality for 249 Causes of Death, 1980–2015: A Systematic Analysis for the Global Burden of Disease Study 2015. [(accessed on 7 December 2018)]; Available online: .
    1. Global Status Report on Noncommunicable Diseases 2010. [(accessed on 30 September 2014)]; Available online: .
    1. Lim S.S., Vos T., Flaxman A.D., Danaei G., Shibuya K., Adair-Rohani H., Amann M., Anderson H.R., Andrews K.G., Aryee M., et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224–2260. doi: 10.1016/S0140-6736(12)61766-8.
    1. Costa Rica . Ministerio de Salud, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud, Caja Costarricense del Seguro Social y Organización Panamericana de la Salud. Encuesta Multinacional de Diabetes Mellitus, Hipertensión Arterial y Factores de Riesgo Asociados, Área Metropolitana, San José, 2004. El Ministerio; San José, Costa Rica: 2009. pp. 12–15.
    1. Caja Costarricense del Seguro Social . Vigilancia de los Factores de Riesgo Cardiovascular. Segunda Encuesta, 2014. Editorial Nacional de Salud y Seguridad Social; San José, Costa Rica: 2016. pp. 34–92.
    1. Wong R. Perfil actual de la hipertensión arterial en Costa Rica 2013. Caja Costarricense de Seguro Social; San Jose, Costa Rica: 2013. p. 15.
    1. Blanco-Metzler A., Moreira Claro R., Heredia-Blonval K., Caravaca Rodríguez I., Montero-Campos M.A., Legetic B., L’Abbé M.R. Baseline and Estimated Trends of Sodium Availability and Food Sources in the Costa Rican Population during 2004–2005 and 2012–2013. Nutrients. 2017;9:1020. doi: 10.3390/nu9091020.
    1. World Health Organization . Guideline: Sodium Intake for Adults and Children. WHO; Geneva, Switzerland: 2012. p. 2.
    1. World Health Organization . Scaling Up Action against Noncommunicable Diseases: How Much Will It Cost? WHO; Geneva, Switzerland: 2011. p. 12.
    1. Public Health Agency of Canada and Pan American Health Organization Dropping the Salt; Proceedings of the Mobilizing for Dietary Salt Reduction Policies and Strategies, Americas; Miami, FL, USA. 13–14 January 2009; Miami, FL, USA: Pan American Health Organization; 2009. p. 7.
    1. Trieu K., Neal B., Hawkes C., Dunford E., Campbell N., Rodriguez-Fernandez R., Legetic B., McLaren L., Barberio A., Webster J. Salt Reduction Initiatives around the World-A Systematic Review of Progress towards the Global Target. PLoS ONE. 2015;10:e0130247. doi: 10.1371/journal.pone.0130247.
    1. Hyseni L., Elliot-Green A., Lloyd-Williams F., Kypridemos C., O’Flaherty M., Orton L., Bromley H., Cappuccio F.P., Capewell S. Systematic review of dietary salt reduction policies: Evidence for an effectiveness hierarchy? PLoS ONE. 2017;12:e0177535. doi: 10.1371/journal.pone.0177535.
    1. Declaración Política Sobre La Prevención De Las Enfermedades Cardiovasculares Mediante La Reducción De La Ingesta DE Sal Alimentaria De Toda La Población. [(accessed on 2 October 2018)]; Available online: .
    1. Nilson E., Jaime P., Resende O. Initiatives developed in Brazil to reduce sodium content of processed foods. Rev. Pan. Salud Publica. 2012;32:287–292. doi: 10.1590/S1020-49892012001000007.
    1. Combris P., Goglia R., Henini M., Soler L.G., Spiteri M. Improvement of the nutritional quality of foods as a public health tool. Public Health. 2011;125:717–726. doi: 10.1016/j.puhe.2011.07.004.
    1. Hendriksen M., Hoogenveen R., Hoekstra J., Geleijnse J., Boshuizen H., van Raaij J.M.A. Potential effect of salt reduction in processed foods on health. Am. J. Clin. Nutr. 2014;99:446–453. doi: 10.3945/ajcn.113.062018.
    1. Costa Rica . Ministerio de Salud. Plan Nacional Para la Reducción del Consumo de Sal/Sodio en la Población de Costa Rica, 2011–2021. El Ministerio; San José, Costa Rica: 2011. pp. 3–20.
    1. Declaración de interés Programa para reducir el consumo de sal/sodio en Costa Rica Decreto Ejecutivo DM-MG-1083-2013. [(accessed on 4 October 2018)]; Available online: .
    1. Costa Rica . Ministerio de Salud. Estrategia Nacional Abordaje Integral de las Enfermedades Crónicas No Transmisibles y Obesidad 2014–2021. El Ministerio; San José, Costa Rica: 2014. p. 29.
    1. Ministerio De Salud, Alianza PúBlico-Privada Ministerio De Salud Y AsociacióN Costarricense De La Industria Alimentaria (Cacia) Para Implementar Acciones Y Fomentar Estilos De Vida Saludable, Asociados Particularmente Al Sodio, Que Incluyen Una AlimentacióN Saludable Y Equilibrada, Nutricionalmente Adecuada. [(accessed on 4 October 2018)];2014 Available online:
    1. Walmart acordó compra de las cadenas Perimercados, Súper Compro y Saretto Transacción se informó este 19 de julio a la Comisión para la Promoción de la Competencia de Costa Rica e incluiría 52 tiendas con más de 1.300 empleados. [(accessed on 8 July 2019)]; Available online:
    1. ¿Dónde se ubican los supermercados en Centroamérica? [(accessed on 23 August 2019)]; Available online: .
    1. Dunford E., Webster J., Metzler A.B., Czernichow S., Mhurchu C.N., Wolmarans P., Snowdon W., L’Abbe M., Li N., Maulik P.K., et al. International collaborative project to compare and monitor the nutritional composition of processed foods. Eur. J. Prev. Cardiol. 2012;19:1326–1332. doi: 10.1177/1741826711425777.
    1. App Store Preview The George Institute for Global Health. Data Collector Application 2014. [(accessed on 3 October 2018)]; Available online: .
    1. Bernstein J.T., Franco-Arellano B., Schermel A., Labonté M., L’Abbé M.R. Healthfulness and nutritional composition of Canadian prepackaged foods with and without sugar claims. Appl. Physiol. Nutr. Metab. 2017;42:1217–1224. doi: 10.1139/apnm-2017-0169.
    1. Tabla de Composición de Alimentos de Centroamérica. [(accessed on 27 December 2018)]; Available online: .
    1. Etiquetado General de los Alimenticios Previamente Envasados (Preenvasados) [(accessed on 27 December 2018)]; Available online: .
    1. Etiquetado Nutricional de Productos Alimenticios Preenvasados Para Consumo Humano Para la Poblacion a Partir de 3 Años de Edad. [(accessed on 27 December 2018)]; Available online: .
    1. Estrategia Regional para la Reducción del consumo de sal y sodioen Centroamérica y República Dominicana. [(accessed on 2 January 2019)]; Available online: .
    1. Ministerio De Salud Y Cacia Renuevan Alianza Para Reducir Sodio en Productos Procesados. [(accessed on 15 June 2019)]; Available online: .
    1. Buttriss J.L. Food reformulation: The challenges to the food industry. Proc. Nut. Soc. 2013;72:61–69. doi: 10.1017/S0029665112002868.
    1. Allemandi L., Tiscornia M.V., Ponce M., Castronuovo L., Dunford E., Schoj V. Sodium content in processed foods in Argentina: Compliance with the national law. Cardiovasc. Diag. Ther. 2015;5:197–206.
    1. Salt Smart Consortium Consensus Statement to Advance Target Harmonization by Agreeing on Regional Targets for the Salt/Sodium Content of Key Food Categories. [(accessed on 3 October 2018)]; Available online: .
    1. Nestlé . In: Nestlé in Society: Creating Shared Value and Meeting our Commitments 2013. Nestlé S.A., editor. Public Affairs; Vevey, Switzerland: 2014. p. 53.
    1. The Call For Well-being 2014 Progress Report. [(accessed on 22 July 2019)]; Available online: .
    1. Unilever’s Position on Salt Reduction. [(accessed on 22 July 2019)]; Available online: .
    1. Nutrition in Unilever Means Better Products, Better Diets, Better Lives For Our Consumers. [(accessed on 22 July 2019)]; Available online: .
    1. Campbell N., Legowski B., Legetic B., Ferrante D., Nilson E., Campbell C., L’Abbé M.R. Targets and Timelines for Reducing Salt in Processed Food in the Americas. J. Clin. Hypertens. 2014;16:619–623. doi: 10.1111/jch.12379.
    1. Public Health England . Salt Reduction Targets for 2017. Public Health England; London, UK: 2017. p. 4.
    1. Arcand J., Au J.T., Schermel A., L’Abbé M.R. A comprehensive analysis of sodium levels in the Canadian packaged food supply. Am. J. Prev. Med. 2014;46:633–642. doi: 10.1016/j.amepre.2014.01.012.
    1. Sodium Reduction in Processed Foods in Canada: An Evaluation of Progress toward Voluntary Targets from 2012 to 2016. [(accessed on 27 December 2018)]; Available online: .
    1. Nilson E.A.F., Spaniol A.M., Goncalves V.S.S., Moura I., Silva S.A., L’Abbé M.R., Jaime P.C. Sodium Reduction in Processed Foods in Brazil: Analysis of Food Categories and Voluntary Targets from 2011 to 2017. Nutrients. 2017;9:742. doi: 10.3390/nu9070742.
    1. Arcand J., Blanco-Metzler A., Benavides Aguilar K., L’Abbé M.R., Legetic B. Sodium Levels in Packaged Foods Sold in 14 Latin American and Caribbean Countries: A Food Label Analysis. Nutrients. 2019;11:369. doi: 10.3390/nu11020369.
    1. Blanco-Metzler A., Roselló-Araya M., Núñez-Rivas H.P. Situación basal de la información nutricional declarada en las etiquetas de los alimentos comercializados en Costa Rica. ALAN. 2011;6:87–95.
    1. Fitzpatrick L., Arcand J., L’Abbe M., Deng M., Duhaney T., Campbell N. Accuracy of Canadian food labels for sodium content of food. Nutrients. 2014;6:3326–3335. doi: 10.3390/nu6083326.

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