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Strategies to Reduce Sodium Intake in the United States (2010)
Food and Nutrition Board (FNB)

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. "6 The Food Environment: Key to Formulating Strategies for Change in Sodium Intake." Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press, 2010.

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Strategies to Reduce Sodium Intake in the United States

challenged by limited data. Conjecture and reaching beyond the data should be avoided, but several hypotheses can be outlined.

The consumer message that sodium is linked with hypertension has been consistent throughout the years. However, messages on who should reduce sodium, and best methods for reducing intake have shifted. Initially, messages most strongly encouraged higher-risk groups (e.g., African Americans and older adults) to reduce sodium, and use of salt at the table and during cooking was emphasized. As in most areas of emerging scientific research, as evidence became stronger that sodium should be a concern throughout the lifespan and as new data emerged on major sources of intake, messages were adjusted to include the entire population, and to encourage consumers to consume processed and restaurant/foodservice foods that were lower in sodium. It is reasonable to expect some consumers to be confused by—or even dismissive of—the slight change in messaging or to never adopt the revised message. This may have limited some consumer interest in reducing intake or in seeking information about how to best accomplish reductions.

Motivation may have also been a challenge. Some consumers may see hypertension as a commonplace, treatable condition in our society, and not recognize the serious ramifications of excess sodium intake. The low levels at which consumers recognize the potential for sodium intake to influence risk of heart disease, speak to this point. The channels used for dispersing sodium messages may have also been insufficient. In addition, it is possible that a portion of the population may simply be uninterested in health messages, and no amount of consumer messaging will motivate behavior change.

Sustainability of consumer interest and concern is another obvious problem. Although early public health initiatives increased awareness, concern levels, and intentions to alter sodium intake, these levels of awareness and concern subsequently declined. Competing messages in the food environment about the importance of a range of nutrients are likely to impact the sustainability of consumer interest and concern over sodium. The problem of public health messages competing for consumer attention is not unique to sodium.

The above mentioned factors cannot be documented and are largely hypotheses, but it seems apparent that even those personally concerned about sodium were also unable to reduce intake. The food supply undoubtedly played a key role in challenging such consumers, but it is also likely that consumer skills for interpreting the sodium content of their diet may have been lacking. Further, while the food industry did make a number of efforts to introduce lower sodium foods during the long history of sodium initiatives, many low-sodium products failed in the marketplace. Likely reasons for these failures were detailed further and include the lack of satisfactory

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191
Front Matter (R1-R12)
Summary (1-16)
1 Introduction (17-28)
2 Sodium Intake Reduction: An Important But Elusive Public Health Goal (29-66)
3 Taste and Flavor Roles of Sodium in Foods: A Unique Challenge to Reducing Sodium Intake (67-90)
4 Preservation and Physical Property Roles of Sodium in Foods (91-118)
5 Sodium Intake Estimates for 2003–2006 and Description of Dietary Sources (119-152)
6 The Food Environment: Key to Formulating Strategies for Change in Sodium Intake (153-212)
7 The Regulatory Framework: A Powerful and Adaptable Tool for Sodium Intake Reduction (213-234)
8 Committee's Considerations and Basis for Recommendations (235-284)
9 Recommended Strategies to Reduce Sodium Intake and to Monitor Their Effectiveness (285-296)
10 Next Steps (297-316)
Committee Member Biographical Sketches (317-324)
Appendix A: Acronyms, Abbreviations, and Glossary (325-334)
Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations (335-356)
Appendix C: International Efforts to Reduce Sodium Consumption (357-404)
Appendix D: Salt Substitutes and Enhancers (405-408)
Appendix E: Background on the National Health and Nutrition Examination Surveys and Data Analysis Methods (409-416)
Appendix F: Sodium Intake Tables (417-442)
Appendix G: National Salt Reduction Initiative Coordinated by the New York City Health Department (443-452)
Appendix H: Federal Rulemaking Process (453-456)
Appendix I: Nutrition Facts Panel (457-458)
Appendix J: State and Local Sodium Labeling Initiatives (459-466)
Appendix K: Approach to Linking Universal Product Code (UPC) Sales Data to the Nutrition Facts Panel (467-468)
Appendix L: Public Information-Gathering Workshop Agenda (469-472)
Index (473-494)