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Strategies to Reduce Sodium Intake in the United States
appropriate for a daily diet while only contributing perhaps 3 percent of a desirable nutrient from the consumer’s perspective (for example, calcium), consumers can better balance their food choices. Moreover, the presence of this information on the packaged food label could incentivize the food industry overall to develop foods with better “nutrition profiles.”
At the time of NLEA implementation, FDA explored approaches to set the quantitative nutrition information within the context of a total daily diet (Levy et al., 1996; Lewis and Yetley, 1992). No single format proved best for all tasks, but the use of a percentage of a reference intake scored the highest. So, for each nutrient to be declared within the Nutrition Facts panel, FDA developed a DV. Generally, for essential nutrients, a reference value for adequate intake is used as the basis for the DV. For non-essential nutrients, such as total fat, saturated fat, and cholesterol, a reference value related to intake above which there may be harm to health is used (Taylor and Wilkening, 2008a). The current DVs were issued through notice-and-comment rulemaking and finalized in 1993.
A challenge occurred in 1993, however, in that the National Academy of Sciences (NAS) had not provided reference values for a number of nutrients and food components that the NLEA required be listed on the food label, sodium among them. Accordingly, FDA turned to the available authoritative consensus documents and extracted from them reference intakes that could form the basis for DVs for nutrients and food components without Recommended Dietary Allowances (RDAs) from the NAS. In the case of sodium, the NAS 1989 consensus report known as Diet and Health:Implications for Reducing Chronic Disease Risk was used because it suggested that an intake of more than 6 g of salt (2,400 mg of sodium) per day was associated with elevated blood pressure (NRC, 1989). The value 2,400 mg became the DV used in the Nutrition Facts panel, and the levels of sodium in a serving of food have been expressed as percentage of this DV (i.e., a percentage of 2,400 mg) since that time.
Changes to the Daily Value for Sodium
Reference values for nutrients have been established beginning in the 1940s under the auspices of the National Research Council (NRC) of the NAS. In 1994, the IOM of the National Academies began a process to expand the reference values in that instead of providing a single number meant to be a recommended intake for each of the more than 25 age, gender, or life stage groups, a set of reference values is given for each nutrient for each group. The reference values are listed in Box 7-1 where it should be noted that an Adequate Intake (AI) is established when it is not possible to determine an Estimated Average Requirement (EAR) (and in turn an RDA).