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There are approximately 5 million Americans with congestive heart failure,14 and a mainstay of their treatment is spironolactone, which blocks the hormone aldosterone and is associated with hyperkalemia. Indeed, a study from Canada showed that shortly after a publication reported a positive effect of spironolactone use in patients with congestive heart failure, its use increased markedly and resulted in a more than 400 percent increase in hospitalizations due to hyperkalemia, and mortality rose from 0.3 per 1,000 to 2.0 per 1,000 patients (Juurlink et al., 2004).

The number of Americans potentially at risk for adverse effects from potassium intake warrants vigilance in the increased use of potassium chloride as a salt substitute. Systematic monitoring of the food supply is essential for tracking the use of potassium chloride in foods and to monitor, and in turn mitigate, its ability to cause adverse health effects in those at risk.


The need for monitoring and surveillance is critical to establishing baseline data for and tracking the progress of strategies to reduce sodium intake. Both data on population intake and data on sodium levels in the food supply are needed to provide an information base for implementation of the recommended strategies. More accurate assessment and tracking of (1) specific foods that are contributors to Americans’ sodium intake and (2) population-level dietary sodium intake, including the monitoring of 24-hour urinary sodium, were recently recommended by an IOM committee charged with reviewing public health strategies for reducing and controlling hypertension in the U.S. population (IOM, 2010). To date, monitoring efforts have been basic and focused on estimating intake from dietary self-reports collected as part of national surveys. Systematic and relevant approaches to tracking the sodium content of the food supply are lacking. Furthermore, useful and informative surveys conducted at the national level—such as the Total Diet Study and the Food Label and Package Survey—have not been conducted systematically, have failed to release data in timely and useful formats, and do not include sufficient coverage of sodium-related measurements. Although available food composition databases, which are essential to formulating sodium intake estimates based on dietary recall methods, have improved over the years, there is still room for more comprehensive data collection and reporting, especially in the area of restaurant foods.

Importantly, a more accurate measure of total sodium intake such as 24-hour urine collection should be employed in national population surveys, specifically NHANES. Dietary estimation must continue because it


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