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Strategies to Reduce Sodium Intake in the United States
PAST RECOMMENDATIONS AND MAJOR INITIATIVES
The 1969 White House Conference on Food, Nutrition, and Health is often regarded as the starting point for national initiatives to reduce sodium intake. Beginning in 1969 and continuing through the present time, numerous initiatives have been developed by a myriad of government public health agencies (FDA, 1975–2007; HHS, 1979–2000; NHLBI, 1972–2006; Senate, 1977; state and local agencies, 2008–2009; USDA, 1993–2008; USDA/HHS, 1980–2005; White House, 1969); independent national and international authoritative scientific bodies (NRC/IOM, 1970–2010; WHO, 1990–2003); and health professional organizations (ADA, 2007; AHA, 1973–2008; AMA, 1979–2006; APHA, 2002). These initiatives have ranged in scope from sweeping national dietary recommendations and goal-setting activities to fact sheets for consumers and health professionals, to calls for food industry and government actions to create or alter policies that might help to reduce sodium intake. When combined, these various initiatives have played a role in attempting to reduce the sodium intake of Americans.
Too numerous to describe in detail, these efforts are listed in Table 2-1 and summarized in Appendix B. Many of these initiatives were developed as part of a public process that involved scientists, consumers, and members of the food industry. Their existence demonstrates the level of resources and effort that have been mustered to reach the goal of lowering sodium intake. Many of these activities disseminated relevant information to consumers directly as well as to the food industry and to “multipliers” such as health professionals and the media. Some of the messages about sodium were linked to other public health messages and campaigns focusing on dietary factors (e.g., increased consumption of fruits and vegetables, decreased saturated fat intake) and chronic diseases and other health conditions with diet-related risk factors (e.g., heart and other cardiovascular diseases, obesity and overweight, cancer, diabetes, osteoporosis, bone health). The food industry and consumer advocacy groups also provided consumer information on the topic.
At the federal level, the National Heart, Lung, and Blood Institute (NHLBI) within the National Institutes of Health has served as a federal leader in the area of dietary sodium reduction by providing a number of enabling tools for dietary change related to sodium intake. Early efforts included sponsorship of the National High Blood Pressure Education Program (NHBPEP). This was a cooperative effort involving professional and voluntary health agencies, state health departments, and community groups with the goal of reducing death and disability related to high blood