**1. Introduction**

Reduction in salt intake was considered by the World Health Organization (WHO) in 2018 as one of the best investments to reduce Non-Communicable Diseases (NCDs) [1]. NCDs are the leading cause of death in the world. It is estimated that they are responsible for 41 million deaths in the world each year, which represents 71% of all deaths [2]. Cardiovascular diseases (CVD) and cancer account for most of those deaths [2]. In Spain, the Global Burden Disease (GBD) 2019 and data from WHO showed that 9 out of the 10 main causes of death are NCDs [3–5].

Raised blood pressure is the leading metabolic risk factor in the world contributing to NCDs [2]. High sodium/salt intake has been associated with high blood pressure and is a risk factor for NCDs [6,7]. In addition, excess sodium intake has been related to coronary heart disease and stroke [6].

According to the World Cancer Research Foundation (WCRF), there is strong evidence that consuming foods preserved by salting is a cause of stomach cancer [8]. High dietary salt has also been shown to adversely affect the vasculature, heart, kidneys, skin, brain and bone [9].

**Citation:** Beltrá, M.; Borrás, F.; Ropero, A.B. Sodium Content of Foods Sold in the Spanish Market. Results from the BADALI Project. *Nutrients* **2021**, *13*, 3410. https:// doi.org/10.3390/nu13103410

Academic Editor: Pedro Moreira

Received: 13 August 2021 Accepted: 25 September 2021 Published: 27 September 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

As a consequence of all the evidence, WHO stablished the maximum recommended sodium intake for adults in 2 g/d in 2012 [10]. According to the GBD, the global mean intake of sodium was 3.95 g/d in 2010 [11]. Salt/sodium intake in the Spanish population is also higher than recommended. The last estimation performed by 24 h urinary sodium excretion was of 9.8 g salt/d, with 88.2% of the subjects with intakes above 5 g/d [12]. More recent data from the ANIBES study, following a three-day food records, also showed an excess of sodium intake in Spain [13].

Randomized trials demonstrate that salt reduction lowers blood pressure in normotensive, as well as in hypertensive individuals additively to antihypertensive treatments [14]. Studies have shown that decreasing salt intake is associated with reduced risk of CVD, all-cause mortality, kidney disease, stomach cancer and osteoporosis [14]. A recent study estimated the impact of the salt reduction program in England. Salt intake decreased from 2000 to 2018 [15]. Authors calculated that maintaining the salt intake at 2018 levels would reduce considerable the cases of premature ischemic heart disease and strokes [15]. This would generate more than half million of extra quality-adjusted life-years and £1640 million health care cost savings for the adult population in England [15].

Most sodium intake in Europe and Northern American countries comes from salt added in manufactured foods (around 75% of the total intake) [16]. Therefore, reducing salt content in processed foods and ready meals is one of the main strategies for decreasing sodium intake in the population [17]. Salt reducing programs have been ongoing for some years in countries such as UK [18], Canada [19], Argentina [20], Brazil [21,22], Italy [23] and South Africa [24]. Recently, WHO released global sodium benchmarks depending on the food category [25]. Maximum sodium values were set in those programs for food groups such as bread, processed meat and fish, canned vegetables and legumes, snacks, breakfast cereals, sauces, among others.

In 2018, the Spanish Agency for Food Safety and Nutrition (AESAN), along with food professionals, released the Plan for the Improvement of the Composition of Food, Beverages and Other Measures 2020 for the period 2017–20 [26]. Reducing added sugar, salt and trans fatty acids content in foods were the main targets [26]. Snacks, processed meat, sauces, vegetable purees, ready to eat and precooked foods were the groups included in the plan for a 5–16% reduction in sodium content [26]. Joining the plan was voluntary.

In the last few years, the sodium content of foods has been studied over time. Results are diverse and depend on the food category and the country of study [27–34]. In Spain, a government report in 2015 showed a decrease in sodium content in some food categories in 2012 compared to 2009 [35]. No scientific publication has been released so far with the results of the Plan 2020.

The aim of the present work is to characterize the presence of sodium in foods sold in the Spanish market in recent years and to analyse a possible reduction over time. This study will focus on food groups.
