Rev Panam Salud Publica 29(2), 2011 69
Feasibility of salt reduction in
processed foods in Argentina
Daniel Ferrante,1 Nicolas Apro,2 Veronica Ferreira,2 Mario Virgolini,1
Valentina Aguilar,2 Miriam Sosa,2 Pablo Perel,3 and Juan Casas 3
Objective. To assess an intervention to reduce salt intake based on an agreement with the
food industry.
Methods. Salt content was measured in bakery products through a national survey and bio-
chemical analyses. Low-salt bread was evaluated by a panel of taste testers to determine
whether a reduced salt bread could remain undetected. French bread accounts for 25% of the
total salt intake in Argentina; hence, reducing its salt concentration from 2% to 1.4% was pro-
posed and tested. A crossover trial was conducted to evaluate the reduction in urinary sodium
and blood pressure in participants during consumption of the low-salt bread compared with
ordinary bread.
Results. Average salt content in bread was 2%. This study evaluated low-salt bread con-
taining 1.4% salt. This reduction remained mostly undetected by the panels of taste testers. In
the crossover trial, which included 58 participants, a reduction of 25 milliequivalents in 24-
hour urine sodium excretion, a reduction in systolic blood pressure of 1.66 mmHg, and a re-
duction in diastolic blood pressure of 0.76 mmHg were found during the low-salt bread intake.
Conclusions. The study showed that dietary salt reduction was feasible and well accepted
in the population studied through a reduction of salt content in bread. Although the effects on
urinary sodium and blood pressure were moderate, a countrywide intervention could have a
greater public health impact.
Sodium, dietary; food habits; nutrition policy; bread; blood pressure; Argentina.
ABSTRACT
In countries with low adult mortality
and medium infant mortality (1), high
blood pressure is the leading cause of
death. Hypertension is estimated to cause
50 000 deaths per year in Argentina (2).
Salt intake is a main determinant of el-
evated blood pressure and is associated
with the increase in blood pressure re-
lated to aging (3) and increased risks of
stroke and coronary heart disease (4).
Salt reduction based mainly on volun-
tary agreements with the food industry
is considered one of the most cost-
effective interventions (5). Population-
based observational studies and com-
munity trials have shown a direct
relationship between salt consumption
and blood pressure in the population (6).
Interventions aimed at reducing salt
intake at the individual level have been
shown to effectively reduce blood pres-
sure, as described in a meta-analysis of
long-term randomized trials (7). How-
ever, the medical advice needed to
achieve a significant reduction in salt in-
take requires intensive interventions and
is not feasible for primary health care
settings (8). Moreover, intense individ-
ual intervention has low feasibility in
developing countries because of a lack
of resources (8) and low external validity
(9). However, these interventions pro-
vide an estimate of a decreased risk of
events by reducing salt intake (10).
Population-based education and mass
media interventions (11–15) have shown
reductions in salt intake. Moreover, re-
ductions in blood pressure observed in
Key words
Investigación original / Original research
Ferrante D, Apro N, Ferreira V, Virgolini M, Aguilar V, Sosa M, et al. Feasibility of salt reduction in
processed foods in Argentina. Rev Panam Salud Publica. 2011;29(2):69–75.
Suggested citation
1 Ministry of Health, Health Promotion, Buenos
Aires, Argentina. Send correspondence to Daniel
Ferrante, dferrante@msal.gov.ar
2 Instituto Nacional de Tecnología Industrial,
Centro de Cereales y Oleaginosas, San Martín,
Argentina.
3 London School of Hygiene and Tropical Medicine,
London, United Kingdom.

European MONICA (monitoring trends
and determinants in cardiovascular
disease) cohorts were attributed not to
use of antihypertensive drugs but to
reduced salt intake and other lifestyle
modifications (16).
Although evidence from developed
countries indicates that population-
based salt reduction policies, especially
focused on sodium reduction in pro-
cessed foods, may be feasible (17), data
about the effectiveness and the impact of
such interventions remain limited in de-
veloping countries. Experiences in de-
veloping countries did not include struc-
tured approaches to reducing salt levels
in processed foods, which can be a less
expensive and more straightforward
way to reduce salt intake than mass
media and educational activities, which
maintain their effect only while they are
in place (18).
In Argentina, one in three adults has
elevated blood pressure, and hyperten-
sion diagnosis and treatment are not
optimal (19). Health authorities are com-
mitted to improving primary health care
of hypertensive subjects and to reducing
salt intake in the population. This may
be achieved by reducing the salt content
in processed foods and by launching ed-
ucational and community interventions
and mass media campaigns targeted at
changing dietary habits (20).
Argentineans eat nearly 12 g of salt
per day, 65% to 70% of which comes
from processed foods (21). Bread consti-
tutes an important source of salt intake,
as the mean daily bread consumption is
190 g per capita, and the estimated mean
salt content is about 2% (22), which
amounts to 25% (4 g) of the total salt in-
take. This fact provides an opportunity
to take action with a single sector in
order to obtain benefits for the general
population (23).
This study assessed the baseline sta-
tus of salt content in bakery products
and evaluated the potential impact of
salt reduction based on technological as-
pects and consumers’ preferences. Then,
the suggested reduction was imple-
mented and intermediate outcomes
were assessed mainly through 24-hour
urinary sodium analysis, which is con-
sidered the gold standard for estimating
sodium intake. For this report, salt is
mentioned when referring to food prod-
ucts, and sodium (40% of salt is sodium)
is mentioned when referring to urinary
analyses.
METHODS
The study was conducted in 2006 and
2007 and had three phases: 1) analysis of
salt content in bakery products in a sam-
ple of bakeries throughout the country,
2) development of reduced salt bread
with a panel of taste testers and food
technology assessments, and 3) a cross-
over trial to assess the feasibility and
impact of the intervention.
Analysis of salt content
in bakery products
The salt content in bakery products
was assessed in a representative sample
of bakeries from Argentina affiliated
with a national federation, the Argen-
tinean Federation of Bakeries (FAIPA).
The sampling frame of bakeries includes
the 25 000 bakeries countrywide affili-
ated with FAIPA. A probabilistic sample
design was followed, and bakeries were
randomly selected to estimate an ex-
pected mean salt content of 2 g per 100 g
of final product in French bread, with an
error of 0.1 g. A sample of 1 250 bakeries
was required.
Measurements performed in each se-
lected bakery included a questionnaire
and biochemical analyses. The self-
administered questionnaires were mailed
to the respondents. Questions included
the amount of salt used per kilogram of
flour and per final product and knowl-
edge of salt functions in bakery products
and interest in participating in the ela-
boration of products with lower salt
content.
For biochemical analyses, a random
subsample of only 26 bakeries was in-
cluded because of financial constraints.
Flame photometric determination of salt
concentration was used with validated
equipment at the National Institute of In-
dustrial Technology (24). The purpose of
these measurements was to estimate po-
tential bias in reporting the salt content
of French bread (the most consumed
product), not to obtain a national mean
value. The mean value, range, and devi-
ation between the real value and the self-
reported value were estimated.
Development of reduced salt bread
At this stage, a formula was devel-
oped to make lower-salt bakery prod-
ucts. For the sensory analysis, two pan-
els were formed: a 20-participant expert
panel of taste testers and a panel of 100
participants from the community. Salt
levels in breads tested by the panels
ranged from 0.6 to 4.2 g per kg of bread.
The objective of the expert panel
analysis was to obtain a threshold of salt
reduction that would remain undetected
by consumers. The expected outcome
was a 20% to 25% decrease in the salt
content of bread.
Expert panel members were part of
the staff of the Food Technology Institute
from the city of 9 de Julio. Their objective
was to establish a concentration of salt
in bread that remained undetected from
the control. The control bread had a salt
concentration that was the average ob-
tained from the surveys and analyses
from bakeries.
The 20 selected panelists blind-tasted
four pairs of bread in each session (25).
In each pair, one slice of bread was the
control (i.e., 1.8% salt) and the other had
a salt concentration ranging from 1.0% to
1.8%. For statistical analysis, the chi-
squared test was used.
The consumer panel included 100 men
and women of different age groups from
the city of 9 de Julio who were invited to
participate, mostly consumers contacted
at the bakeries. The purpose of this panel
was to establish a salt concentration that
ordinary consumers would accept. Con-
sumers participated in two sessions.
First, they tasted seven breads with salt
concentrations ranging from 0.6% to
4.2% in a blinded manner. After they
tried the breads, an acceptance zone was
developed according to their opinions
between two thresholds: rejection zone
for low-salt flavor and rejection zone for
salty flavor. The optimum salt content
was determined as that having the small-
est rejection rate. Each bread was scored
by panelists between 1 (“I do not like it, it
is horrible”) and 10 (“I like it a lot”).
Analysis of variance models were used to
test differences in acceptability (26).
Second, consumers participated in
paired comparison trials. Fifty consumers
tested 1.6% and 1.8% salt-containing
bread and the other 50 tested 1.5% and
1.8% salt-containing bread. This stage was
developed to determine whether a moder-
ate salt reduction—from the average mar-
ket salt level—could remain undetected.
Results were statistically significant when
all P values were less than 0.05.
The final recommendation of both
panels was to achieve a salt level that
represented a significant decrease in salt
70 Rev Panam Salud Publica 29(2), 2011
Original research Ferrante et al. • Feasibility of salt reduction in processed foods in Argentina

intake but that could also be well ac-
cepted and tested for reduction of salt in-
take in the third phase.
Crossover trial to assess the feasibility
and impact of the intervention
Objectives. The main objective of the
third phase was to assess the impact of
the salt reduction intervention in French
bread in the city of 9 de Julio.
Design. A randomized 2 × 2 crossover
trial was designed with one group ran-
domly assigned to a normal-to-low-salt
bread sequence and the other group to a
low-to-normal-salt bread sequence (27).
Normal-salt bread contained 2.0% salt,
and low-salt bread contained 1.4% salt,
based on the results of the panels of taste
testers.
Population. Adults aged 18 years or
older from the adult population living in
the city of 9 de Julio, Argentina, were
included. Adults working in the health
sector and in the municipality were in-
vited to participate in the study. Partici-
pants were recruited and randomized at
local hospital facilities, where the assess-
ments took place. Participants did not re-
ceive economic incentives.
Inclusion criteria were systolic blood
arterial pressure between 120 mmHg and
159 mmHg, normotensive or hyperten-
sive participants under treatment without
changes in treatment or diet during the
last month, and consumption of bread.
Exclusion criteria were symptomatic
heart disease, renal failure or blood crea-
tinine concentration higher than 1.5 mg
per dL, use of diuretics, diabetes mellitus
treatment with insulin, special dietary
requirements such as a prescribed very-
low-salt diet or celiacs, consumption of
more than one alcoholic drink a day, and
any other condition that in the investiga-
tors’ opinion did not allow the patient to
be included.
Procedures and measurements. Trial
duration was 35 days. On the first visit,
baseline data were obtained and partic-
ipants were randomized by telephone
using a centralized telephone system.
Subjects were randomized to either a
normal-to-low-salt bread sequence or to a
low-to-normal-salt one. Each stage lasted
15 days, with a 5-day washout period.
All participants were instructed to con-
tinue their diets during the study with-
out changing the amount or type of salt
used. However, they were advised to
avoid foods with a very high salt content
if they did not usually consume them.
They were also instructed to report any
changes in their blood pressure medica-
tions. Participants received a diary where
they reported daily food intake.
Four bakeries participated in the study.
Participants continued to purchase bread
on a daily basis from their usual bakeries
where the personnel assigned French
bread with an unknown concentration of
salt to the participants. Evaluators were
also blinded to the sequence.
At baseline, after the first phase, and
after the second phase, participants col-
lected repeated 24-hour urine samples
and health professionals measured their
blood pressure. Patients were instructed
to follow routine recommendations be-
fore blood pressure measurements. At
each visit, two measurements of right-
arm blood pressure were performed by
trained personnel using international
standards (28).
Ethics
The protocol was approved by a lo-
cal ethics committee. All subjects pro-
vided written informed consent and
were free to withdraw from the study at
any time. Data retrieved from subjects
were confidential.
Statistical analyses:
sample size and tests
Baseline data were described using
proportions for categorical variables and
means and standard deviations for con-
tinuous variables. The following linear
model was used to analyze the crossover
trial (29):
Yijk = µ + sequencei + subjectij + periodk
+ treatmenth + eijk
where
Yijk = sodium concentration in urine (or
systolic and diastolic blood pres-
sure, according to each of the
three models used) for each sub-
ject, sequence, and period;
µ = overall mean of sodium concen-
tration (or systolic and diastolic
blood pressure, same as above);
and
eijk = error term for each subject, se-
quence, and period.
Mean urinary 24-hour sodium excre-
tion was the dependent variable. A lin-
ear model was built to test the hypothe-
sis of no difference between low-salt and
normal-salt bread diets on 24-hour uri-
nary excretion. Blood pressure (systolic
and diastolic) was included in another
analysis with a similar linear model. The
sequence effect was tested to assess
carryover effects.
The potential reduction in salt intake
implied a reduction of salt in bread of 1.0
to 1.2 g per day (the expected value be-
fore the survey and before the panels of
taste testers). This value could explain a
reduction of 20 milliequivalents (meq) in
24-hour sodium excretion according to
previous studies (30). Considering a
standard deviation of 45 meq per day, a
sample of at least 54 patients was needed
in a crossover comparison to detect this
difference, with 80% power and an alpha
error of 5%. The software R was used for
all statistical analyses.
RESULTS
Phase 1: questionnaire and analytical
results
Of the 25 000 bakeries, 1 250 were in-
cluded in the sample. Since approxi-
mately 1 500 bakeries were invited, the
response rate was 83.3%. The bakeries
included were from all around the coun-
try and varied in size. Bakeries in Ar-
gentina are usually small family busi-
nesses, and no big chains are operating
in the market. The assessment, as re-
ported by the bakers, provided the fol-
lowing average salt contents: French
bread = 1.8% (range 1.0% to 4.0%), crois-
sants and cookies = 1.8% (range 1.0% to
3.5%), crackers = 2.9% (range 2.2% to
5.0%), and flat rounded crackers = 2.1%
(range 1.2% to 3.4%). Only French bread
samples were chemically analyzed. The
average of the 26 samples analyzed
suggested a mean salt concentration of
0.8%, equivalent to a salt content of 2.0%
in French bread, ranging from 1.4% to
3.0%. The difference between self-
reported salt content and measured salt
content was 0.2%.
There was considerable variability
among the different bakeries, which im-
plies a wide variety of methodologies
and recipes (data not shown).
Regarding the perceptions of bakers
about the role of salt in bread making,
92.2% reported a role in flavor, 67.4% a
Rev Panam Salud Publica 29(2), 2011 71
Ferrante et al. • Feasibility of salt reduction in processed foods in Argentina Original research

role in color, 30.7% a role in water and
gas retention, 22.3% a role in elasticity,
49.9% affecting yeast activity, 24.5% af-
fecting acidity, and 49.8% having a role
in the crusty cortex.
Phase 2: expert panel of taste testers
and consumers
Panelists were able to detect when
bread had a salt content lower than 1.4%
(P = 0.132) (Table 1). Most expert pan-
elists detected lower salt concentrations
when bread had less than 1.4% salt.
A control sample with a salt content of
1.8% was used for all comparisons. The
estimation of salt concentration in bread
detected as less salty was 1.4%. The rec-
ommended concentration was 1.4% to
1.5% salt to be adopted for further test-
ing with regular consumers.
Consumers rated seven French breads
with different salt concentrations (rang-
ing from 0.6% to 4.2%) (Table 2). Bread
with salt concentrations of 1.8%, 2.4%,
and 3.0% had more consumer acceptance.
The samples with lower acceptance had
either very low (0.6%) or very high (4.2%)
salt concentrations.
In a different session, 50 consumers
tried and compared two breads, with
salt contents of 1.8% and 1.5%, and the
other 50 evaluated breads with salt con-
tents of 1.8% and 1.6%. There were no
significant differences in consumers’
preferences in both comparisons (1.8%
vs. 1.5% P = 0.08, 1.8% vs. 1.6% P = 0.1).
Although the bread with 1.4% salt was
not the most accepted, the difference
between the usual concentration (1.8%
to 2%) and 1.4% was mostly undetected
and fairly well accepted.
Therefore, bread with 1.4% salt con-
tent was tested in the crossover trial to
assess its potential to reduce overall salt
intake.
Phase 3: results from crossover trial on
urinary sodium and blood pressure
In this phase, 98 volunteers were
screened, and 58 signed the informed
consent. Of the 40 subjects who were not
included, 16 were disqualified because
of the presence of exclusion criteria (10
required low-salt diets, 3 were using di-
uretics, and 3 consumed more than one
alcoholic drink per day) and 24 declined
to participate, mainly because they did
not want to collect 24-hour urine sam-
ples. Nonparticipants were mainly men
(72.5%) and younger (mean age 32 years)
than the subjects included in this phase.
Of the 58 subjects, 29 were randomly
assigned to a normal-to-low-salt bread
sequence and 29 were assigned to a low-
to-normal-salt bread sequence.
Baseline population characteristics are
provided in Table 3. Participants pur-
chased daily bread from their bakeries as
mentioned above.
Baseline urinary excretion in the 58
subjects was 160 meq per day (range
60–288, standard deviation 53). Mean
age was 39 years, 29.1% were men, hy-
pertension was present in 34.6% of par-
ticipants, and 18.1% of participants were
already controlling salt in their diet.
However, 69.1% of participants reported
cooking with salt and 34.3% said they al-
ways added salt to their meals (Table 3).
Compared with the normal-salt bread
diet, the low-salt bread diet was asso-
ciated with a reduction of 25.3 meq in
24-hour urinary sodium (95% confi-
dence interval [CI] 6.9 to 43.7, P = 0.0086)
(Table 4) (Figure 1). Neither order nor se-
quence was significant.
Although it was not the main outcome
of the study, systolic blood pressure was
compared between groups. Systolic blood
pressure decreased 1.66 mmHg with the
low-salt bread diet (95% CI 0.52–2.74,
P = 0.0059). Neither order nor sequence
was significant, providing no evidence
of carryover effects.
There was also a small but significant
reduction in diastolic blood pressure
of 0.76 mmHg (95% CI 0.08–1.44,
P = 0.0297) during the low-salt bread pe-
riods. No significant sequence or order
effect was observed in blood pressure
comparisons.
DISCUSSION
Baseline salt content in bakery prod-
ucts was high and had wide variability
among bakeries nationwide. In general,
bakers did not know that the main role of
salt in bakery products is for flavor, and
most of them prepared their products
without measuring the salt they added.
A bread with lower salt content could
be developed and remain undetected
compared with regular bread even after
a significant salt reduction There was
fairly good acceptability among con-
sumers of bread with lower salt content.
The low-salt bread showed urinary
sodium reductions in a sample of volun-
72 Rev Panam Salud Publica 29(2), 2011
Original research Ferrante et al. • Feasibility of salt reduction in processed foods in Argentina
TABLE 1. Results from expert panel of taste testers (n = 20): iden-
tification of lower-salt breads compared with control (1.8% salt),
Argentina, 2007
Salt concentration Number of panelists
in bread sample who correctly identified
(%) lower-salt bread P value
1.0 19 < 0.0001
1.1 19 < 0.001
1.2 16 0.006
1.3 17 0.001
1.4 13 0.132
1.5 15 0.021
1.6 12 0.252
1.7 13 0.132
TABLE 2. Results from panel of consumers: average acceptability
for each bread sample (scale of 1–10), Argentina, 2007
Salt concentration Average score of acceptability
in bread sample (%) among 100 consumers
0.6 4.3a
1.2 5.5b
1.8 6.5c,d
2.4 7.0d
3.0 6.9d
3.6 5.8b,c
4.2 4.9a,b
Note: Levels of salt with the same letters indicate no difference in multiple compar-
isons by analysis of variance.

teers. These volunteers could not detect
the difference between products. The in-
tervention in bakeries was feasible and did
not imply additional costs for bakers or
consumers. Reduction in daily sodium ex-
cretion estimated at 25 meq is equivalent
to a salt intake reduction of 1.2 to 1.4 g.
Previous experiences in developing
countries focused on communication
campaigns and changes in use of table
salt (31). However, in many developing
countries most salt intake comes from
processed foods, such as bread. There-
fore, it is important to adapt successful
experiences from developed countries.
In the United Kingdom, for example,
through voluntary agreements with the
Ministry of Health and the food indus-
try, relevant reductions in the salt con-
tent in processed foods have been at-
tained in the past few years (17).
In Argentina, French bread is the main
source of dietary salt intake. As there are
no significant technological constraints to
reduce salt concentration, the develop-
ment of lower-salt bread that is still ac-
ceptable to consumers is feasible and
could represent a good opportunity to
have a positive impact on the population.
As hypertension is the leading cause of
burden of disease in Argentina, a public
policy to reduce salt intake seems to be a
worthwhile recommendation. Moreover,
in the context of difficult access to blood
pressure monitoring and chronic treat-
ment (19), population-based strategies
such as salt reduction in processed foods
can be highly cost-effective not only for
people with hypertension but also for the
general population.
The limitations of this study include fi-
nancial constraints that did not allow for
analyzing a larger sample and those re-
lated to crossover experiments (26), which
typically include using the same subjects
as controls, and the uncertainty of carry-
over effects. A carryover effect was not
relevant in any of the three analyses. For
blood pressure reduction, the study was
underpowered, and biases in measure-
ments could have been introduced, as dig-
ital measurements of blood pressure were
not implemented. However, evaluators
were blind to the assigned groups, thus
making observers’ biases less unlikely.
Although this experiment contributed
to testing the methods for assessment of
acceptability of salt-reduced products, a
wider assessment of consumer prefer-
ences in representative samples around
the country is needed. In the same direc-
tion, ways to implement the changes in
bread production need to be planned
using these lessons learned but on a
larger scale.
In Argentina, after these results were
available, a wider implementation and
evaluation was suggested, also includ-
ing local communication strategies. Sim-
ilar strategies could be applied to other
food products, considering Argentina’s
consumption patterns and technological
feasibility.
The public health implications of these
results could be relevant even when the
amount of reduction in salt intake is
small. A reduction of only 1 g per person
per day in salt intake could avoid thou-
sands of cardiovascular events per year
in Argentina. In addition to the high con-
sumption of bread in Argentina, Argen-
tinean bread has higher amounts of salt
than bread in other countries, such as the
United States of America (1.75%), New
Zealand (1.3%), and Australia (1.1%) (32).
Rev Panam Salud Publica 29(2), 2011 73
Ferrante et al. • Feasibility of salt reduction in processed foods in Argentina Original research
TABLE 3. Baseline characteristics of participants in a crossover trial of low and normal levels of
salt in bread, Argentina, 2007
High to low salt Low to high salt
Characteristic (n = 29) (n = 29) P value
Females (%) 62.9 78.5 0.2
Mean age ± SD (years) 41.5 ± 12.4 37.1 ± 9.1 0.13
With elevated blood pressure or treatment for
hypertension (%) 40.7 28.6 0.34
Use salt in cooking (%) 74.1 64.3 0.43
Use salt at table (%) 22.2 46.3 0.06
Consume low-salt diet (%) 25.9 10.7 0.14
Mean baseline sodium excretion ± SD
(milliequivalents/24 hours) 158.6 ± 47.2 160.3 ± 58.9 0.86
Mean baseline systolic blood pressure ± SD (mmHg) 114.4 ± 11.6 113.8 ± 10.5 0.85
Mean baseline diastolic blood pressure ± SD (mmHg) 66.3 ± 5.4 67.4 ± 6.1 0.45
Note: SD: standard deviation.
TABLE 4. Change in urinary sodium and blood pressure for low and normal levels of salt in
bread: 24-hour urine sodium and blood pressure in 58 participants (paired comparisons in cross-
over trial), Argentina, 2007
Mean change between
Normal-salt bread Low-salt bread low- and normal-salt
Outcome (mean ± SD) (mean ± SD) bread (95% CI) P value
24-hour urinary sodium excretion
(milliequivalents per 24 hours) 165.3 ± 60.3 140.1 ± 53.3 –25.3 (–6.9 to –43.7) 0.0086
Systolic blood pressure (mmHg) 114.4 ± 8.2 112.71 ± 7.8 –1.7 (–0.5 to –2.8) 0.0056
Diastolic blood pressure (mmHg) 67.6 ± 4.9 66.88 ± 4.6 –0.8 (–0.1 to –1.4) 0.0286
Note: SD: standard deviation, CI: confidence interval.
100
Baseline Post 1st period Post 2nd period
125
150
175
200
24
-h
u
rin
ar
y s
od
ium
e
xc
re
tio
n
(m
eq
/da
y) A–B
B–A
FIGURE 1. Change in 24-hour urine sodium by group (A = normal sodium, B = low sodium),
Argentina, 2007

A further reduction accomplished by
including more food sectors, changing
the local codex alimentarius reducing
maximum approved salt concentrations,
appropriate labeling, health warnings,
and implementing communication and
education campaigns could produce a
significant reduction in salt intake and
therefore have a greater impact on car-
diovascular events.
This study describes an experience
with one relevant sector of the food chain
and shows promising results. Countries
in the Americas have expressed their will
to work in reducing the population’s salt
intake, supported by the Pan American
Health Organization, and Argentina has
already started this process (33). The
World Health Organization also advo-
cates for countries to start actions to re-
duce salt consumption, and these recom-
mendations are supported by current
evidence of the excess risk imposed by an
elevated salt intake (34).
Salt levels in bread are high, contribut-
ing significantly to overall salt intake.
However, a reduction in salt concentra-
tion is feasible, is well accepted, and re-
sults in a reduction in salt intake that
could be related to a significant public
health benefit. This approach could
apply to other food sectors. Other coun-
tries in the Americas, with diet patterns
similar to those in Argentina, could ad-
vance in a similar direction and learn
from its successes and failures.
74 Rev Panam Salud Publica 29(2), 2011
Original research Ferrante et al. • Feasibility of salt reduction in processed foods in Argentina
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Ferrante et al. • Feasibility of salt reduction in processed foods in Argentina Original research
Objetivo. Evaluar una intervención destinada a reducir el consumo de sal a partir
de un convenio con la industria alimentaria.
Métodos. Se midió el contenido de sal de los productos de panadería por medio de
una encuesta nacional y análisis bioquímicos. Un grupo de catadores evaluó el pan
con bajo contenido de sal para determinar si la disminución pasaba inadvertida. Dado
que el pan francés representa 25% del consumo total de sal en la Argentina, se pro-
puso someter a prueba este tipo de pan con una disminución de la concentración de
sal de 2% a 1,4%. Se realizó un estudio cruzado con el fin de evaluar si los partici-
pantes presentaban una concentración urinaria de sodio más baja y una presión arte-
rial menor durante el período en que consumieron pan con bajo contenido de sal res-
pecto del período en que consumieron pan común.
Resultados. El pan común contiene un porcentaje promedio de sal de 2%. En este es-
tudio, el pan con bajo contenido de sal contenía 1,4%, disminución que, en general,
pasó inadvertida a los catadores. En el estudio cruzado, en el que participaron 58 su-
jetos, la eliminación urinaria de sodio disminuyó 25 miliequivalentes en 24 horas, la
presión arterial sistólica bajó 1,66 mmHg y la presión arterial diastólica bajó 0,76
mmHg durante el período en que los participantes consumieron pan con bajo conte-
nido de sal.
Conclusiones. El estudio demuestra que es factible reducir la ingesta de sal alimen-
taria y que la población estudiada considera aceptable que el pan contenga esta menor
concentración de sal. Aunque los efectos sobre la concentración urinaria de sodio y la
presión arterial fueron moderados, es probable que una intervención nacional tenga
repercusiones más importantes para la salud pública.
Sodio en la dieta; hábitos alimenticios; política nutricional; pan; presión sanguínea;
Argentina.
RESUMEN
Factibilidad de reducir
el contenido de sal
de los alimentos procesados
en la Argentina
Palabras clave