Lack of food industry legislation costs millions of lives - review

Perception of uncertainty about the effects of salt reduction has allowed the food industry to get away without legislation at the cost of millions of easily-avoided deaths, says an Australian review.

The review was published in the journal Current Hypertension Reports, which publishes reports by international experts on significant developments in the field of hypertension.

Lead author Professor Bruce Neal, of The George Institute and The University of Sydney, compares the food industry to the tobacco industry, “with several recent reports documenting patterns of behaviour comparable to those used by tobacco manufacturers”.

Regulating the food industry is the only way forward, the review says.

Salt is added to food as flavouring, and to extend shelf life. 

“Unfortunately the commercial success of the food industry has been a public health disaster. Diet-related ill health is now the leading cause of premature death and disability in most countries around the world."

“The food industry is the new vector of global disease, causing epidemics of high blood pressure, obesity and diabetes caused by salt, sugar and fat,” Professor Neal says.

For salt, a series of recent studies have, however, shown a range of different results – in some, higher salt intake is associated with a higher risk of cardiovascular disease, while in others it’s the opposite.

Professor Neal is undeterred, suggesting that the differences between these studies are to do with the quality of the research and do not raise genuine uncertainty about the effects of salt on health.  

He highlights the small number of participants in key studies and the difficulty of working out whose good diet kept them healthy versus who switched to a better diet because they got sick. Other problems cited were the difficulties of getting people to collect the 24 hour urine samples required to properly measure salt intake, and the fact that people who are ill tend to report more favourable dietary patterns than they have actually been eating.

Of particular concern, says Professor Neal, was the recent revelation that data included in a major review in the prestigious international journal Heart may have been falsified. This required the complete retraction of the paper which had suggested an adverse effect of salt reduction on heart failure.

Neal also highlights the interests that many have groups have in prolonging the debate and the simplistic reporting of some studies. Vested interests, he says, “have exploited the vacuum”.

“The real winner has been the food industry, which has been able to continue business as usual with little pressure to reduce the salt content of it foods.”

Professor Neal says there is, in fact, more than enough research to act upon. And that, when considered as a whole, the data strongly supports significant adverse effects of salt on human health, and likely substantial benefits from reducing salt.

In the UK alone, a campaign costing about 15 million pounds is reported to have saved more than 1.5 billion pounds and resulted in about 9,000 fewer deaths from cardiovascular diseases.

Professor Neal is calling for regulation to mandate levels of salt in food, saying the benefits would be very large for a relatively small investment.

"The strongest evidence is for mandated regulatory interventions that modify salt levels across the food environment. This would provide industry with a level playing field and everyone would win," he says.