In 1969, the White House Conference on Food, Nutrition, and Health issued recommendations that, among other important nutrition concerns, highlighted the role of sodium in hypertension and marked the starting point of public health initiatives to address the high levels of sodium intake among the U.S. population. Forty years later, in January 2009, the first meeting of the Institute of Medicine (IOM) Committee on Strategies to Reduce Sodium Intake convened. In the intervening years, much had changed—what we eat, where we eat, and who prepares our food. However, in spite of the attempts of many in both the public health community and the food industry, what did not change is the amount of sodium we consume each day, largely in the form of salt. High sodium intake puts the whole population—young and old, male and female, all ethnic groups—at risk for hypertension and subsequent cardiovascular events such as heart failure and stroke.

Hypertension is extraordinarily common: 32 percent of adult Americans have hypertension, and roughly another third have pre-hypertension. The costs of these health conditions are staggering. Estimates place the direct and indirect costs of hypertension at $73.4 billion in 2009.

The committee’s charge was to recommend strategies to reduce Americans’ intake of sodium to levels consistent with the Dietary Guidelines for Americans. In the wake of the many unsuccessful and/or unsustainable efforts, this was no small task, but—in light of the potential public health benefit that could be achieved if the goal was met—it was a worthy one. Simply put, the task of the committee was broad, far-reaching, and complex. I am delighted that the assembled committee had the individual expertise and experience as well as the collective will to serve the health of the public and the willingness to meet the significant challenge of our charge. It was a privilege to be a part of this effort.

Over the course of the study, we met often and consulted many sources. Our first meeting set the tone as we heard from each of our study sponsors. A subsequent public hearing elicited needed input and was extremely useful to the committee’s deliberations. Invited speakers and panelists included Paul Breslin, Cindy Beeren, Ed Roccella, Susan Borra, Michael R. Taylor, Fred Degnan, Philip Derfler, Cliff Johnson, Alanna Moshfegh, Eric Hentges, Corinne Vaughan, Vanessa Hattersley, Ed Fern, Chor San Khoo, Todd Abraham, Douglas Balentine, Deanne Brandstetter, Stephanie Rohm Quirantes, and Elizabeth Johnson. A host of persons chose to share their perspectives and experience with us on that day and afterward by input to the committee’s website. We sought specific advice and analysis regarding current dietary patterns, a better understanding of restaurants and others in the foodservice industry, and the range of options available for consideration from a regulatory perspective. Each request was met fully and greatly facilitated our work.

On behalf of the committee, I extend our deepest thanks to the able project staff of the Institute of Medicine: Christine Taylor, study director; Caitlin Boon, program officer; Heather Del Valle, associate program officer; Emily Ann Miller, research associate; Marianne J. Datiles, senior program assistant; and Saundra Lee, senior program assistant. All gave generously of their talents and time. Our committee benefited greatly from their industry and guidance as we deliberated on our approach and challenges. In addition, the committee would like to thank other members of the Food and Nutrition Board staff including Linda Meyers, director; Sheila Moats, associate program officer; Alice Vorosmarti, research associate; Julia Hogland, research associate; Heather Breiner, program associate; Anton Bandy, financial officer; and Geraldine Kennedo, administrative assistant, who assisted at critical times during the project. On behalf of the committee, I would also like to thank David Vladeck for his service as a committee member from October 2008 until May 2009. Further, the committee would like to thank Mathematica Policy Research, Inc. for providing data analyses.

In the view of the committee, the recommendations in this report, when undertaken, will result in the desired decrease in sodium intake across the U.S. population. To this end, we are grateful to have been a voice for this important initiative that will now require the commitment of many.

Jane E. Henney, Chair

Committee on Strategies to Reduce Sodium Intake