Excerpt

This report focuses on strategies to reduce the sodium intake of the U.S. population. In Fall 2008, a 14-member committee was convened at the request of Congress and supported by several agencies within the HHS. The committee’s work was predicated on the importance of reducing sodium intake and the agreement that achieving lower intakes is a critical public health focus for all Americans. No segment of the population is immune from the adverse health effects, despite the common misunderstanding that sodium intake is a concern only for the “salt sensitive” and the elderly. Consistent with its charge, the committee relied upon consensus conclusions from numerous authoritative bodies as support for the health benefits related to population-based sodium reductions.

The committee was asked to make recommendations about various means that could be employed to reduce dietary sodium intake to levels recommended by the Dietary Guidelines for Americans—currently, less than 2,300 mg/d (see Box 1-1, Statement of Task). The recommended strategies were to include actions by food manufacturers, government approaches such as regulations and legislation, and public and professional outreach and education. Figure S-1 illustrates the committee’s approach to its task.

The committee began its study by evaluating the outcomes of past and current efforts to reduce sodium intake. It explored knowledge about sensory preferences for salt and its role in modulating overall food flavor, key factors in strategies to reduce sodium intake. Preservation and physical property roles of sodium in food were reviewed. Background information was obtained on food manufacturing and restaurant/foodservice operations and on factors important to understanding consumer food choices and behaviors. Given that regulatory options were to be considered, the committee also characterized the current regulatory framework. Further, the committee reviewed the possibility of leveraging activities through food specifications set by large government food purchasers, explored economic incentives such as a salt tax, and noted sodium reduction activities in other countries. It also considered the potential of innovative technologies for salt substitutes and enhancers as well as culinary advances.

Finally, the committee integrated the information into a series of discussions that led to conclusions about the strategies to be recommended, implementation tasks, and information gaps.

Contents

• The National Academies
• Committee on Strategies to Reduce Sodium Intake
• Reviewers
• Preface
• Summary
  • THE CHALLENGES
  • APPROACHING THE TASK
  • CONTEXT FOR THE RECOMMENDATIONS
  • RECOMMENDATIONS
  • IMPLEMENTATION OF RECOMMENDATIONS AND INFORMATION GAPS
  • CLOSING REMARKS
• 1. Introduction
  • THE TASK
  • THE APPROACH
  • REFERENCES
• 2. Sodium Intake Reduction: An Important But Elusive Public Health Goal
  • PAST RECOMMENDATIONS AND MAJOR INITIATIVES
  • OUTCOMES
  • FINDINGS
  • REFERENCES
• 3. Taste and Flavor Roles of Sodium in Foods: A Unique Challenge to Reducing Sodium Intake
  • SALT THROUGH ANCIENT TIMES
  • TASTE VERSUS FLAVOR
  • SALT TASTE: HUMAN PERCEPTION AND PREFERENCE
  • SALT FLAVOR EFFECTS
  • MECHANISMS OF SALT TASTE
  • EVOLUTION OF SALT TASTE PERCEPTION AND PREFERENCE
  • EARLY DEVELOPMENT OF HUMAN SALT TASTE
  • MAINTAINING FOOD ACCEPTABILITY WHILE REDUCING SODIUM IN FOODS
  • REFERENCES
• 4. Preservation and Physical Property Roles of Sodium in Foods
  • FOOD SAFETY AND PRESERVATION
  • PHYSICAL PROPERTIES OF FOOD
  • FUNCTIONS OF SODIUM IN SPECIFIC FOOD CATEGORIES
  • REFERENCES
• 5. Sodium Intake Estimates for 2003–2006 and Description of Dietary Sources
  • ESTIMATING SODIUM INTAKE
  • CURRENT SODIUM INTAKE OF THE U.S. POPULATION
  • TRENDS IN SODIUM INTAKE: NHANES 1971–1974 THROUGH 2003–2006
  • CHARACTERIZING SODIUM IN THE FOOD SUPPLY
  • MONITORING
  • REFERENCES
• 6. The Food Environment: Key to Formulating Strategies for Change in Sodium Intake
  • MANUFACTURING AND RETAILING OF PROCESSED FOODS WITHIN THE FOOD ENVIRONMENT
  • PRODUCTION AND DELIVERY OF RESTAURANT/FOODSERVICE FOODS WITHIN THE FOOD ENVIRONMENT
  • LARGE-SCALE GOVERNMENT FOOD PROCUREMENT AND FOOD ASSISTANCE PROGRAMS
  • STATE AND LOCAL GOVERNMENTS
  • THE CONSUMER
  • THE CONSUMER WITHIN THE FOOD ENVIRONMENT
  • REFERENCES
• 7. The Regulatory Framework: A Powerful and Adaptable Tool for Sodium Intake Reduction
  • REGULATION TO ENSURE SAFETY OF SUBSTANCES ADDED TO FOODS BY MANUFACTURERS
  • REGULATION TO REQUIRE NUTRITION INFORMATION AND TO SET STANDARDS FOR LABEL CLAIMS
  • APPLICATION OF FEDERAL REGULATIONS TO RESTAURANT/FOODSERVICE OPERATIONS
  • STATE AND LOCAL MENU LABELING INITIATIVES
  • REFERENCES
• 8. Committee’s Considerations and Basis for Recommendations
  • LESSONS LEARNED FROM CONSUMER-ORIENTED PUBLIC HEALTH INITIATIVES
  • INFORMATION FROM SODIUM INITIATIVES IN OTHER COUNTRIES
  • THE POSSIBILITY OF ECONOMIC INCENTIVES
  • TECHNOLOGICAL ADVANCES
  • THE OPPORTUNITY TO LEVERAGE SODIUM REDUCTION BY USE OF FOOD PURCHASE SPECIFICATIONS AND FOOD ASSISTANCE REQUIREMENTS
  • POTENTIAL FOR CHANGES IN THE REGULATORY STATUS OF SALT
  • SUPPORTING CONSUMERS TO MAKE DIETARY BEHAVIOR CHANGES
  • POTENTIAL UNINTENDED CONSEQUENCES OF REDUCING SODIUM ACROSS THE U.S. POPULATION
  • MONITORING
  • CLOSING REMARKS
  • REFERENCES
• 9. Recommended Strategies to Reduce Sodium Intake and to Monitor Their Effectiveness
  • PRIMARY STRATEGIES
  • INTERIM STRATEGIES
  • SUPPORTING STRATEGIES
• 10. Next Steps
  • IMPLEMENTATION OF STRATEGIES
  • RESEARCH NEEDS
  • REFERENCES
• Committee Member Biographical Sketches
• Appendixes
  • Appendix A Acronyms, Abbreviations, and Glossary
  • Appendix B Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations
  • Appendix C International Efforts to Reduce Sodium Consumption
  • Appendix D Salt Substitutes and Enhancers
  • Appendix E Background on the National Health and Nutrition Examination Surveys and Data Analysis Methods
  • Appendix F Sodium Intake Tables
  • Appendix G National Salt Reduction Initiative Coordinated by the New York City Health Department
  • Appendix H Federal Rulemaking Process
  • Appendix I Nutrition Facts Panel
  • Appendix J State and Local Sodium Labeling Initiatives
  • Appendix K Approach to Linking Universal Product Code (UPC) Sales Data to the Nutrition Facts Panel
  • Appendix L Public Information-Gathering Workshop Agenda

This study was supported by Contract No. 200-2005-13434, Task Order No. 14, between the National Academy of Sciences and the Centers for Disease Control and Prevention; Contract No. N01-OD-4-2139, Task Order No. 219, between the National Academy of Sciences and the National Institutes of Health, National Heart, Lung, and Blood Institute; Contract No. HHSF223200811156P between the National Academy of Sciences and the Food and Drug Administration; and Contract No. HHSP233200800635P between the National Academy of Sciences and the Office of Disease Prevention and Health Promotion.

Suggested citation:

IOM (Institute of Medicine). 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press.

Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.