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. 2015 Apr 24;10(4):e0123915. doi: 10.1371/journal.pone.0123915

Table 2. Input parameters relating to the interventions effects (for further details see S1 File).

Intervention Sources and extra details Key values and uncertainty (average adult) a
Counselling: Dietary counselling by dietitians to reduce sodium intake (part of current practice). The data obtained for the NZ setting are detailed in an online report [55]. For the effect size on sodium we used the results of the trials included in a 2013 Cochrane systematic review [56]. For the per hour impact of counselling: 7.6 mmol/d reduction (with uncertainty based on the initial trials in the Cochrane review. SD = 0.8 mmol/d). Normally distributed. Total amount of counselling in NZ: 4600 h/year (SD = 920). Gamma distribution.
Endorsement Label Programme: A programme involving an endorsement label (part of current practice). The non-governmental organisation “the Heart Foundation” runs an endorsement label programme called the “Tick Programme”. Its estimated impact are in an online report [57] and published letter [58]. Effect size: 1.7 mmol/d reduction overall (38 mg/d) with SD at +/- 20% (-1.0 to -2.3 mmol/d). Normally distributed.
Mandatory-3G: Mandatory reduction of sodium in the manufacture of breads, processed meats and sauces Based on the relative contributions of sodium to the NZ diet (based on national nutrition survey data) we estimated the impact of a hypothetical mandatory reduction of sodium in three groups of processed foods: breads, processed meats and sauces (i.e., the top three categories for sodium intake in NZ). A 25% reduction of sodium in each group was assumed to result from setting mandatory upper levels for sodium, giving a reduction in intake of 296 mg/d (12.9 mmol/d). Effect size: 12.9 mmol/d reduction overall with SD at +/- 10% of this. Normally distributed.
Mandatory-All: Reduction of sodium in all processed foods by 25%. As above for the Mandatory-3G intervention, except the 25% reduction was applied to all major types of processed foods (i.e., excluding sodium intakes from: fresh fruit and vegetables, fresh fish and meat, and also salt added in cooking and at the table). The estimate obtained was a reduction of sodium intake of 525 mg/d or 22.8 mmol/d (equivalent to 1.4 g/d out of 9.1 g/d salt intake currently or 15% of current adult intake). Effect size: 22.8 mmol/d reduction overall with SD at +/- 10% of this. Normally distributed.
UK Package: The mix of media campaign, voluntary food reformulation and food labelling changes The intervention was that actually used in the 2003–2009 period in the UK [59], but applied on a same per capita basis to NZ. This overall programme resulted in a 15% reduction in 24-hour urinary sodium over seven years in the adult population. We used this reduction in our modelling for the NZ population i.e., a 15% reduction in dietary sodium intake over seven years. In the baseline model we assumed that the benefit would stay in place for the lifetime of the modelled cohort (given the longer-term evidence from countries such as Finland [60]). Effect size: 3.2 mmol/d reduction per adult annually over the seven year period (22.7 mmol/d overall) with SD at +/- 10% of this. Normally distributed.
UK Mass Media Campaign: Just the mass media campaign part of the UK Package The mass media campaign component of the UK Package (as per directly above) was applied on the same per capita basis to NZ. There is evidence that this media campaign increased the proportion of UK adults who made an effort to cut down on salt (i.e., from 34% to 43%) and those trying to reduce salt by checking food labels also increased (i.e., from 29% to 50%) [59]. Overall, however, the media campaign has been described as being “not very effective in the long term” [59]. Given this information, and the other actions occurring at the time (industry food reformulation) we assumed a relatively modest role for the campaign—at around 30% of the total package effect size (range in scenario analyses of 15% to 45%). This range is very approximate but has been informed by expert opinion (Personal communication with He and Macgregor who have studied the UK campaign [59]). Effect size: 0.97 mmol/d reduction per adult annually over the seven year period (6.8 mmol/d overall) with SD at +/- 30% of this. Normally distributed.
Salt Tax: An excise tax is applied and increased up to the point where the recommended level of sodium intake is achieved We modelled a hypothetical intervention in which a law was passed requiring an excise tax on salt that would be applied in increasing amounts annually until a target level of population salt intake of 2300 mg/d (5.9 g salt/d) per adult was achieved (the level recommended for NZ adults [61]). We used a price elasticity (PE) for demand of salt from the literature of: -0.1 [62] (varied in scenario analyses). We set the tax levels so that the reduced demand in any one year would never exceed 20%. This meant that it took 10 years to reach the 2300 mg/d target. In the baseline model we assumed that the benefit would stay in place for the lifetime of the modelled cohort. Scenario analyses included a range of other options. Effect size: Variable annual reductions to keep under the maximal level of 20% change in any year. The highest reduction was in the first year at 6.5 mmol/d per adult.
Sinking Lid: The amount of food-grade salt released onto the NZ market is reduced annually to the point where the recommended level of sodium intake is achieved In this hypothetical intervention, a law was enacted requiring a stepwise reduction in the amount of food-grade salt released to the market (i.e., as released by NZ’s single salt manufacturer). The reduction continued until the target level of 2300 mg/d per adult was achieved (as per the Salt Tax). In the baseline model we assumed that it would take six years to achieve the target and that the benefit would stay in place for the lifetime of the modelled cohort. Scenario analyses included a range of other options. Effect size: A reduction in sodium consumption of 9.0 mmol/d per adult each year (until the target is reached).

a Values given for the average adult. In the modelling we adjusted these values for men and women by ratios of 4013/3544 and 3115/3544 respectively, given the variation in sodium intakes (in mg) according to the nutrition survey data [53].