标题：Estimating the Potential Health Impact and Costs of Implementing a Local Policy for Food Procurement to Reduce the Consumption of Sodium in the County of Los Angeles
摘要：Objectives . We examined approaches to reduce sodium content of food served in settings operated or funded by the government of the County of Los Angeles, California. Methods. We adapted health impact assessment methods to mathematically simulate various levels of reduction in the sodium content of food served by the County of Los Angeles and to estimate the reductions’ potential impacts on mean systolic blood pressure (SBP) among food-service customers. We used data provided by county government food-service vendors to generate these simulations. Results. Our analysis predicted that if the postulated sodium-reduction strategies were implemented, adults would consume, on average, 233 fewer milligrams of sodium each day. This would correspond to an average decrease of 0.71 millimeters of mercury in SBP among adult hypertensives, 388 fewer cases of uncontrolled hypertension in the study population, and an annual decrease of $629 724 in direct health care costs. Conclusions. Our findings suggest that a food-procurement policy can contribute to positive health and economic effects at the local level. Our approach may serve as an example of sodium-reduction analysis for other jurisdictions to follow. In a 2010 report, the Institute of Medicine recommended that food retailers, governments, businesses, institutions, and other large-scale organizations that purchase or distribute food establish sodium specifications for the food they purchase and the food operations they oversee. 1 Food-procurement policies limiting sodium content in meals purchased, distributed, or served have been enacted 2 , 3 or considered 4 by several jurisdictions in the United States. Excess consumption of sodium increases blood pressure and can increase the risk of cardiovascular morbidity and mortality. 5 Unfortunately, the average daily consumption of sodium in the United States—more than 3400 milligrams—greatly exceeds the limits recommended in the 2010 Dietary Guidelines for Americans: 2300 milligrams for the general population and 1500 milligrams for Blacks, adults who are middle-aged and older, and hypertensives (the latter 3 groups together account for almost 70% of the US population). 6 – 8 Several population models have predicted that reducing the US population's consumption of sodium on a national basis could have a substantial impact on health and health care costs. 9 – 12 Other studies have demonstrated that elevated blood pressure early in life may be a strong predictor of hypertension in adulthood, which suggests that interventions aimed at reducing the intake of sodium among young persons may help delay or even altogether prevent the onset of hypertension. 13 , 14 Although population models have examined sodium consumption at the national level, data on the potential impact and costs of implementing local policy are lacking. Findings from a previous assessment of the government of the County of Los Angeles, California, suggest that establishing a new policy for food procurement represents a potentially viable approach for reducing sodium consumption locally. In that previous assessment, a majority of the county government representatives interviewed suggested that a food-procurement policy should include department-specific (“venue-based”) nutrition standards. 4 Building on that work, we adapted health impact assessment (HIA) methods to estimate (1) the potential health impacts of a local food-procurement policy on selected populations served by venues operated or funded by the County of Los Angeles and (2) the costs of implementing such a policy (e.g., staffing, training, food costs). Because the primary goal of the policy is to reduce the consumption of sodium in the population, we assessed health impact by using average systolic blood pressure (SBP) and the prevalence of uncontrolled hypertension as indicators of health improvements. We also estimated the associated reduction in direct health care costs that could be achieved.
