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fat intake), was associated with more attributable deaths than any of the other single dietary factors.

The potential societal and medical savings of reducing hypertension and related cardiovascular disease by way of a reduction in population-level sodium intake have been demonstrated in recent analyses (Bibbons-Domingo et al., 2010; Palar and Sturm, 2009; Smith-Spangler et al., 2010). Reducing the average population sodium intake to 2,300 mg/d from current intake levels was estimated to reduce cases of hypertension by 11 million, to save $18 billion in health-care dollars, and to gain 312,000 quality-adjusted life-years that are worth $32 billion annually (Palar and Sturm, 2009). Bibbons-Domingo et al. (2010) developed a projection model that showed a benefit for all population groups from a reduction of salt intake by 3 g (equal to 1,200 mg sodium) per day. This decrease was projected to reduce the number of new cases of coronary heart disease by 60,000, stroke by 32,000, and myocardial infarction by 54,000 per year. Smith-Spangler et al. (2010) estimated that decreasing mean population sodium intake by 9.5 percent would prevent 513,885 strokes and 480,358 myocardial infarctions over the lifetime of adults currently aged 40–85 years, saving $32.1 billion in medical costs.

In summary, the nature of the public health problem associated with excessive sodium intake is serious, directly affects large numbers of people, and is associated with high health-care and quality-of-life costs. Therefore, strong solutions are warranted if it is to be addressed effectively. Because sodium intake is causally related to high blood pressure, an established risk factor for cardiovascular disease, reductions in sodium intake have been seen as an essential component of national public health policy for the past several decades (Loria et al., 2001; USDA/HHS, 2005). Newer data document that this requires continued priority and attention; furthermore, the IOM committee on Public Health Priorities to Reduce and Control Hypertension in the U.S. Population found the evidence base to reduce dietary sodium as a means to shift the population distribution of blood pressure levels convincing (IOM, 2010).

Target Population for Sodium Intake Reduction

Initially, reduction of sodium intake focused on persons considered to be at high risk, such as those with hypertension and older adults. For this report, the committee considered the general population when making recommendations because as new science has emerged, the focus of public health policy has expanded to include the general population as well as high-risk subgroups (Loria et al., 2001). In addition, the lifetime risk of becoming hypertensive for adults is greater than 80 percent (after adjusting for competing causes of mortality) (Vasan et al., 2002), but currently there



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