Nutritional risk factors such as excessive sodium consumption and trans-fat consumption are among the top worldwide causes of death and contribute to the global burden of non-communicable diseases such as cardiovascular disease.

 

To tackle these two nutritional risk factors, WHO and PAHO support their Member States by providing technical assistance. In 2007, PAHO convened the Trans-Fat Free America Task Force, an initiative that issued the Declaration of Rio de Janeiro in 2008, with voluntary commitments to remove industrially produced trans-fatty acids (IP-TFA) from the food supply. While significant progress has been made, this goal has not been achieved, and trans-fatty acids continue to be used as a food ingredient in several Member States. An important lesson learned was that voluntary measures were not sufficient.

Therefore, in 2018, WHO launched the REPLACE action package to support governments in implementing the elimination of IP-TFA from the food supply. WHO has set a target of eliminating worldwide IP-TFA by 2023. In this regard, PAHO is collaborating with Resolve to Save Lives to catalyse the adoption of best practices for IP-TFA elimination.

 

PAHO launched a regional initiative for cardiovascular disease prevention through sodium reduction in 2009, aiming at implementing cost-effective population-based interventions to improve public health in low- and middle-income countries, which are also expected to be cost-effective in high-income countries.

In many countries, three-quarters of sodium intake comes from processed foods, such as bread, cereals and grains, processed meats, and dairy. An effective way to reduce population's intake of sodium is reducing the sodium content in commonly consumed foods.

 

Salt reduction policies targeted specifically at the reduction of the sodium content in foods are necessary and relevant and these must be implemented on a mandatory basis. PAHO/WHO has developed different tools to support Member States, including the updated PAHO Regional Sodium Reduction Targets developed in collaboration with the University of Toronto and launched in October 2021. These targets include maximum thresholds for 75 subcategories, which fall under 16 food category headings. A 15% and 30% reduction were established for 2022 and 2025, respectively, from the measured levels of sodium at the 50th percentile. If the calculated value for 2025 (30% reduction) was below the 25th percentile, the 25th percentile was used as the 2025 target.

 

 The Caribbean Six-Point Policy Package (6-PPP) was established in 2017 to promote healthier food environments and food security to address childhood obesity through policy actions including recommendations to remove artificial trans-fats in all food products and set regional standards and time-bound salt, fat, and sugar reduction targets for specific food categories.

Mandatory approaches for iTFA elimination and sodium reduction provide the legal tools and financial and human resources necessary to guarantee the implementation process and the appropriate monitoring mechanisms in place. Mandatory reformulation could achieve iTFA elimination and larger salt reductions than voluntary agreements and might also achieve higher reductions in disability- and quality-adjusted life years.

The implementation of a regulatory framework creates a level playing field for the food industry (large, small, and medium-sized enterprises). Legislative measures also allow for the introduction of fiscal penalties for non-compliance. Legislation is more difficult to abandon than voluntary measures if a new government comes into power.