Evaluation of the sodium intake reduction plan for a local government and evidence-based reestablishment of objectives: Case of the Seoul Metropolitan Government / 한국영양학회지

PURPOSE: To identify the effectiveness of policy evaluation, consistent monitoring is necessary. This study aimed to carry out mid-term evaluation of objectives and programs related to comprehensive plans for sodium intake reduction by 2020 for Seoul city and then reestablish the objectives of the sodium intake reduction plans. METHODS: Literature reviews, data analysis, and reviews of expert focus-groups were performed to evaluate objectives, to develop a new goal, and to identify the priority subjects of the sodium intake reduction programs. In order to examine target populations for the programs, awareness and behaviors related to sodium intakes among Seoul citizens were examined by sex, age, and income level using the 2008~2013 Korea National Health and Nutrition Examination Survey data. RESULTS: Current objectives of the sodium intake reduction plan by 2020 for Seoul city were not appropriate, so objectives were reset to 3,600 mg of sodium intake by 2020 among Seoul citizens with 2% reduction per year. Although sodium intake showed a decreasing trend by year, it was still high, especially in men. The sodium intake reduction programs currently in progress have not been assessed at multiple levels across multiple sectors and have only been assessed fragmentarily. For dietary behavior related to sodium intakes by sex, age, and income level, sodium intake was higher in the group with less than 100 g of fruit intake compared to the group with 100 g or more. Subjects aged 30~59 years and the low household income group showed relatively higher sodium intakes. Based on the data analysis and the expert review, the priority subject of the sodium intake reduction programs was determined to be adult men. In terms of a program strategy for sodium intake reduction, multi-level and setting approaches, including work sites, home, and restaurants, were suggested to reduce sodium intakes of the target subject. CONCLUSION: The suggested objectives should be consistently monitored by data analysis, and the determined programs need to be phased in over 5 years.

Cost-benefit Analysis of Sodium Intake Reduction Policy in Korea / 대한지역사회영양학회지

It is well established that excessive sodium intake is related to a higher incidence of chronic diseases such as hypertension, stroke, coronary heart disease, cardiovascular disease and gastric cancer. Although the upper limit of the current sodium intake guideline by WHO is set at 2,000 mg/day for adults, sodium intake of Koreans is well over 4,700 mg/capita/day implying an urgent need to develop and implement sodium intake reduction policy at the national level. This study investigated the cost-effectiveness of the sodium intake reduction policy, for the first time, in Korea. Analyses were performed using most recent and representative data on national health insurance statistics, healthcare utilization, employment information, disease morbidity/mortality, etc. The socioeconomic benefits of the policy, resulting from reduced morbidity of those relevant diseases, included lower medical expenditures, transportation costs, caregiver cost for inpatients and income losses. The socioeconomic benefits from diminished mortality included reductions in earning losses and welfare losses caused by early deaths. It is estimated that the amount of total benefits of reducing sodium intake from 4.7 g to 3.0 g is 12.6 trillion Korean Won; and the size of its cost is 149 billion Won. Assuming that the effect of sodium intake reduction would become gradually evident over a 5-year period, the implied rate of average return to the sodium reduction policy is 7,790% for the following 25 years, suggesting a very high cost-effectiveness. Accordingly, development and implementation of a mid-to-long term plan for a consistent sodium intake reduction policy is extremely beneficial and well warranted.