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BOX 8-1

Findings from Review of Public Health Initiatives

  • The lack of success in reducing sodium intake population-wide in the United States indicates that prior initiatives were not sufficient in the face of the nature of the public health problem they are meant to address.

  • Without an overall reduction in the level of sodium in the food supply—that is, the level of sodium to which consumers are exposed on a daily basis—the current focus on instructing consumers and making available reduced-sodium “niche” products cannot result in lowering intakes to levels consistent with the Dietary Guidelines for Americans.

  • Food industry efforts to voluntarily reduce the sodium content of the food supply face technological challenges, are not consistently undertaken by all, are difficult to sustain on a voluntary basis, and in the aggregate have not resulted in overall success.

  • Food manufacturers and restaurant/foodservice operators face challenges in marketing lower-sodium foods in the context of the current food supply because such foods may be considered less palatable than higher-sodium competitors; it is known that food taste is a major determinant of food choice. What is lacking is a level playing field.

  • A factor germane to improving the success of efforts to reduce sodium intake is that persons have become accustomed to high-salt taste, but the preference can be changed. Since a high-salt diet may actually enhance a preference for salt taste, a food supply with high levels of salt may handicap the acceptance of lower-sodium foods.

  • Reductions in the preference for salt taste are likely best accomplished through gradual, stepwise reductions of sodium across the food supply.

tives beginning in 2003, following a national survey in 2000–2001 that suggested an average daily intake of more than 3,800 mg/d of sodium.

The activities in Finland focused on extensive media campaigns in the 1970s and 1980s, during which consumer awareness was the focus. These were followed by required labeling in the 1990s. The labeling is targeted to eight food categories known to be rich sources of salt in the diet: bread, sausages, cheese, butter, breakfast cereals, crisp bread, fish products, and soups, sauces, or ready-made dishes. Those foods that exceed a certain level of salt based on the percentage of salt “by fresh weight of the product” are required to bear a “high-salt” label, while those below certain percentages of fresh weight of product are allowed to bear a “low-salt” label.

In Finland, manufacturers apparently worked to reduce the sodium content of foods in these eight food categories, achieving for example a 10 percent reduction in the sodium content of sausages. Based on sodium excretion measures, the efforts in Finland coincided with a drop in sodium

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