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Appendix B
Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations



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Appendix B Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations 

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TABLE B-1 Government Initiatives  Target Population Date Program/Initiative/Report Title Recommendations/Initiatives/Actions (if specified) White House Conference 1969 Conference on Food, Nutrition, and Provided advice on the desirability of reducing sodium intake Hypertensive Health: Final Report (White House individuals Conference, 1969) Encouraged food processors to minimize the amount of salt in processed Food processors foods Identified a need for food labeling of sodium U.S. Senate—Select Committee on Nutrition and Human Needs 1977 Dietary Goals for the United States, Decrease salt intake to about 5 g/d All Americans 2nd edition (Select Committee on Nutrition and Human Needs, 1977) U.S. Department of Health and Human Serices—Centers for Disease Control and Preention (CDC) 2009 The Congressional Omnibus CDC plans to explore existing national and international public and private Food Appropriations Acta (2009) included initiatives to reduce sodium in the food supply manufacturers language encouraging CDC to work In fiscal years 2009–2010, CDC plans to convene public and private and chain with major food manufacturers stakeholders to build relationships and partnerships to investigate restaurants and chain restaurants to reduce approaches for reducing sodium consumption sodium content in their products CDC will explore knowledge gaps, utilizing its data systems to analyze and and to submit to the Committee on release pertinent sodium related data (CDC, 2009) Appropriations and the House of Representatives and the Senate an evaluation of its sodium-reduction activities within 15 months of enactment of the act, and annually thereafter

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U.S. Department of Health and Human Serices—Surgeon General 1979 Healthy People: Surgeon General’s Consume less salt; cook with only small amounts of salt, avoid adding salt at All Americans Report on Health Promotion and the table, avoid salty prepared foods Disease Prevention (Public Health Service, 1979) 1988 Surgeon General’s Report on Reduce intake of sodium by choosing foods relatively low in sodium and All Americans Nutrition and Health (Public Health limiting the amount of salt added in food preparation and at the table Service, 1988) U.S. Department of Health and Human Serices—Public Health Serice 1980 Promoting Health and Preventing By 1990: All Americans Disease: Objectives for the Nation • Reduce the average daily sodium ingestion (as measured by excretion) for (Public Health Service, 1980) adults to at least the 3,000–6,000 mg range • > 75% of the population should be able to identify the principal dietary factors for high blood pressure and three other diseases • 70% of adults should be able to identify the major foods that are low in sodium • Sodium in processed foods should be reduced by 20% from present levels 1990 Healthy People 2000 (NCHS, 2001) Increase % of persons preparing foods without adding salt from 43% All Americans (baseline) to a target of 65% Increase % of persons rarely or never using salt at the table from 60% (baseline) to 80% Increase % of persons regularly purchasing foods with reduced salt and sodium content from 20 (baseline) to 40% 2001 Healthy People 2000 Review During the mid-1990s, overall the percent of persons rarely or never using All Americans (NCHS, 2001) salt at the table ranged from 56–62%, and the % of persons regularly purchasing foods with reduced salt and sodium content was 19%  continued

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TABLE B-1 Continued  Target Population Date Program/Initiative/Report Title Recommendations/Initiatives/Actions (if specified) 2000 Healthy People 2010 (HHS, 2000) Persons 2 or Increase the percentage of persons who consume ≤ 2,400 mg/d sodium from baseline (21% based on the National Health and Nutrition Examination more years of age Survey [NHANES] 1988–1994) to 65% (only 13% met target in 2003– 2004 [Public Health Service, 2008]) U.S. Department of Health and Human Serices—National Heart, Lung, and Blood Institute (NHLBI), the National Institutes of Health 1972 National High Blood Pressure Cooperative effort among professional and voluntary health agencies, state All Americans Education Program (NHLBI, 2010) health departments, and many community groups with the goal to reduce death and disability related to high blood pressure through programs of professional, patient, and public education 1993 Working Group Report on Primary Reduce salt intake to no more than 6 g per day All Americans Prevention of Hypertension (National High Blood Pressure Education Program) (Whelton et al., 1993) 1995, Statement from the National High Moderate salt and sodium intake 1999 Blood Pressure Education Program Establish 2,400 mg/d sodium as a national dietary goal Coordinating Committee (NHLBI, 1999) 1996 Workshop: Implementing Develop public and professional education activities within the primary Recommendations for Dietary Salt prevention campaign to convey the rationale for and benefits of lowering Reduction: Where Are We? Where dietary salt/sodium for hypertension prevention to the appropriate target Are We Going? How Do We Get audiences There? (NHLBI, 1996) The salt/sodium messages must be consistent with and often integrated into overall healthful lifestyle diet messages, such as the Dietary Guidelines, USDA Food Guide Pyramid, and FDA food labels

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Experiences with intervention studies should be transferred to clinical and/or community settings after reviewing or evaluating and adapting, if necessary, strategies, methods, and materials Gradual “silent” or “transparent” lowering of salt or sodium in the food supply will need to occur along with the opportunity for effective marketing strategies and the promotion of reduced-sodium as well as low-sodium, low-salt, and no-salt food products. These recommendations are applicable to the food production industry, as well as restaurant, catering, and foodservice industries Data from completed clinical trials should be analyzed for the adequacy of simpler methods (e.g., casual urine collections, chloride titrator strips) as measures of sodium intake and for the validity of dietary recalls in order to consider the best feasible methods for individual and national-level assessments of sodium intake Other research needs identified in the areas of food technology; basic mechanisms of salt taste; and knowledge, attitudes, and skills of the public 1997 The Sixth Report of the Joint Reduce sodium intake to ≤ 100 mmol/d (2,400 mg sodium or 6 g sodium National Committee on Prevention, chloride) Detection, Evaluation, and Treatment of High Blood Pressure (NHLBI, 1997) 2002 National High Blood Pressure Reduce dietary sodium intake to no more than 100 mmol/d (approximately All Americans Education Program (update of 1993 2,400 mg of sodium or 6 g of sodium chloride) report) (NHLBI, 2002) 2003 The Seventh Report of the Joint Reduce sodium intake to no more than 100 mmol/d (2,400 mg sodium or 6 g National Committee on Prevention, sodium chloride) Detection, Evaluation, and Treatment of High Blood Pressure (NHLBI, 2004)  continued

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TABLE B-1 Continued 0 Target Population Date Program/Initiative/Report Title Recommendations/Initiatives/Actions (if specified) 2005 Prevent and Control America’s Promoted awareness and education materials to help the public health Persons at High Blood Pressure: Mission community attract new partners and revitalize relationships with existing high risk for Possible (NHLBI with CDC and the partners to fight high blood pressure hypertension American Heart Association [AHA] States distributed materials to public health departments; hospitals and clinics; Low-SES as supporting partners; 22 states schools; senior centers; refugee centers; faith-based organizations; work (socioeconomic participated) (NHLBI, 2005) sites; primary care practices; emergency medical service groups; state health status) and benefit plans; and disease-related organizations, such as diabetes, kidney minority failure, and cancer groups populations 2006 NIH Radio (NIH, 2006) Produced a broadcast-ready public service announcement about fighting high All Americans blood pressure through diet U.S. Department of Agriculture and U.S. Department of Health and Human Serices (USDA/HHS) 1980 Dietary Guidelines for Americans Avoid too much sodium “Most (USDA/HHS, 1980) Americans” 1985 Dietary Guidelines for Americans Avoid too much sodium “Most Americans (USDA/HHS, 1985) . . . those who are already healthy” 1990 Dietary Guidelines for Americans Use salt and sodium only in moderation Healthy (USDA/HHS, 1990) Americans 2 or more years of age 1995 Dietary Guidelines for Americans Choose a diet moderate in salt and sodium. “The Nutrition Facts Label lists A Healthy (USDA/HHS, 1995) Daily Value of 2,400 mg” Americans 2 or more years of age

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2000 Dietary Guidelines for Americans Choose and prepare foods with less salt Healthy (USDA/HHS, 2000) Americans 2 or more years of age 2005 Dietary Guidelines for Americans Americans 2 or Consume < 2,300 mg/d of sodium (~1 tsp salt) (USDA/HHS, 2005) Choose and prepare foods with little salt, and consume potassium-rich foods, more years of age such as fruits and vegetables Individuals with hypertension, African Americans, and middle-aged and older High-risk adults: Aim to consume no more than 1,500 mg/d of sodium, and meet the populations potassium recommendation (4,700 mg/d) with food 2010 Dietary Guidelines for Americans Convened expert Advisory Committee to update the Dietary Guidelines for Americans for the year 2010. Sodium intake is included as a topic area for discussion (results pending) U.S. Food and Drug Administration (FDA) 1973 Food labeling (HHS/FDA, 1973) Required specific format when a nutrition claim was made in labeling or advertising or when a nutrient was added to a food Better information about the sodium content of foods was an early focus 1979 Evaluation of the health aspects Consumption of sodium chloride should be reduced of sodium chloride and potassium Guidelines should be developed for restricting salt in processed foods chloride as food ingredients The sodium content of processed foods should be labeled (SCOGS, 1979) 1981 Initiative with NHLBI (Derby and Educate the public about sodium Fein, 1995) Encourage manufacturers to display the sodium content on food labels  continued

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TABLE B-1 Continued  Target Population Date Program/Initiative/Report Title Recommendations/Initiatives/Actions (if specified) 1982 Rejected petitions requesting Deferred action pending assessment of the impact of reclassification of salt’s status from • Sodium labeling regulations “GRAS” (generally recognized as • Manufacturer efforts to voluntarily reduce salt safe) to “food additive” and the Indicated that a voluntary program would produce the desired results with addition of warning labels to high- less regulatory burden and affirmed that the food industry was in the best sodium foods and salt packets by position to reduce sodium levels in processed foods and should be given a deferring action on GRAS status of chance to do so salt (HHS/FDA, 1982) 1984 Sodium labeling (HHS/FDA, 1984) Sodium added to mandatory list of nutrients to be declared on food labels Defined the terms for sodium content claims 1993– Nutrition Labeling Final Rules Established a Daily Value (DV) of 2,400 mg for sodium labeling 2005 (HHS/FDA, 1993a,b,c, 1994, 2005) Mandated declaration of sodium content on all foods (mg and % DV) Established labeling rules: • Nutrient content claims for “free” (< 5 mg sodium per serving), “low” (≤ 140 mg sodium per serving), and “reduced or less than” (≥ 25% less sodium per serving than an appropriate reference food) • Foods labeled as “healthy” to contain ≤ 480 mg sodium per serving until Jan. 1, 1998, at which time sodium levels were to decrease to ≤ 360 mg per serving • Health claim: “Diets low in sodium may reduce the risk of high blood pressure” (foods ≤ 140 mg per serving) • Disqualifying or disclosure levels (≤ 480 mg per serving) 2005 Final rule regarding sodium levels Retained 1993 level of ≤ 480 mg sodium per serving; eliminated requirement in foods labeled as “healthy” (HHS/ that this level drop to ≤ 360 mg FDA, 2005) Rationale: • Technological barriers to reducing sodium in processed foods • Poor sales of products meeting lower-sodium levels • More restrictive sodium levels would inhibit the development of new “healthy” food products

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2007 Public hearing in response to The petition specifically requested FDA to a 2005 petition (CSPI, 2005) • revoke the GRAS status of salt requesting rulemaking regarding • amend any prior sanctions for salt salt and a House of Representatives’ • require food manufacturers to reduce the amount of sodium in all Committee on Appropriations 2005 processed foods statement encouraging the agency • require health messages on retail packages of salt (0.5 oz.+); reduce the to focus on ways—both voluntary DV for sodium from 2,400 to 1,500 mg by the food industry and regulatory Issues discussed—GRAS vs. food additive status: by FDA and USDA—to reduce salt • Could a food additive regulation be constructed to prescribe limitations in processed and restaurant foods for uses of salt? If so, how? (HHS/FDA, 2007a) • Would reducing the salt content of food, even in a modest way, impact the safety or quality of various foods given the wide variety of technical functions for which salt is used in food? How feasible would it be to mitigate this impact, if true? Could it be mitigated by the addition of other ingredients? • If you agree that the sodium content of processed foods should be reduced, what actions (other than those suggested by the petitioner) would you recommend? • How could FDA partner with interested stakeholders regarding the development of appropriate recommendations or other information to reduce the salt content of processed foods? Issues discussed—food labeling: • What is the effectiveness of FDA labeling regulations in reducing salt intake by the public? • What data are available regarding the potential for label statements about the health effects of salt to reduce salt intake? • To what extent could FDA’s labeling policies provide incentives to manufacturers to reduce the salt content of processed foods?  continued

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TABLE B-1 Continued  Target Population Date Program/Initiative/Report Title Recommendations/Initiatives/Actions (if specified) 2007 Advanced Notice of Proposed Requested comments on questions including: Rulemaking (ANPR): Nutrition • Should the Daily Reference Value (DRV) for sodium be based on Labeling (HHS/FDA, 2007b) the Tolerable Upper Intake Level (UL) for sodium (2,300 mg) or on the Adequate Intake (AI; 1,500 mg/d) using the population-coverage approach? • If the UL is used, should it be adjusted using the same approach (population-weighted or population-coverage) as the other Dietary Reference Intakes (DRIs)? 2007 Public Hearing (HHS/FDA, 2007c) Discussed: use of symbols to communicate nutrition information, consideration of consumer studies and nutrition criteria U.S. Department of Agriculture (USDA) 1993 Nutrition Labeling (USDA, 1993) Adopted similar food labeling provisions as FDA for USDA-regulated products (notably meat and meat products) 1995 Commodity Distribution Program Recommended specific sodium reductions for 10 commodity food categories Children (provides 15–20% of school lunch in USDA’s Commodity Distribution Program: canned beef, pork, poultry, consuming school program foods) luncheon meat, refried beans, salmon, tuna, ready-to-eat cereals, ham, and meals carrots Excluded many other products due to the assumption that school children would find modifications unacceptable (USDA, 1995) 2004 HealthierUS School Challenge Rewards changes in the school nutrition environment, including providing Children and (encourages elementary, middle, lower-sodium foods to all children and youth: youth consuming and high schools to improve the school meals • Gold, silver, or bronze recognition: Foods with ≤ 480 mg sodium per nutrition content of foods provided non-entrée or ≤ 600 mg sodium per entrée to children and youth) (FNS, 2010) • Gold award of distinction: Non-entrées with ≤ 200 mg sodium and entrées with ≤ 480 mg

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2007 Special Supplemental Nutrition Requires that in certain food categories, foods must be lower in sodium or not Low-income, Program for Women, Infants, and have added sodium to qualify as a product that can be purchased with WIC nutritionally Children (WIC) (provides vouchers vouchers at-risk, pregnant to participants for the purchase and postpartum of specific food items to meet women; infants nutritional needs) (USDA/FNS, and children up 2007) to 5 years 2008 Commodity Distribution Program Plans to purchase low-sodium canned vegetables with the goal to reduce Children (FNS, 2008) consuming school sodium levels of all canned vegetables to ≤ 140 mg per serving by school year 2010 meals State and Local (Sodium Labeling Initiaties)b 2008 California Requires restaurant chains with ≥ 20 outlets statewide to disclose sodium information at point of sale 2008 King County (Seattle) Requires posting of sodium content on menus for restaurant chains with ≥ 15 outlets nationwide or $1 million in annual sales (collectively for the chain); if a menu board is used, nutrition information (including sodium) must be provided at point of ordering 2008 Philadelphia Requires posting of sodium content on menus for restaurant chains with ≥ 15 outlets nationwide 2009 Montgomery County (Maryland) Requires restaurant chains with ≥ 20 outlets nationwide to disclose sodium information (in writing) on the premises, upon request 2009 Oregon Requires restaurant chains with ≥ 15 outlets nationwide to provide sodium information on the premises, upon request  continued

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TABLE B-1 Continued  Target Population Date Program/Initiative/Report Title Recommendations/Initiatives/Actions (if specified) Goernment/Non-goernment Organization Partnership 2009 National Salt Reduction Initiative Partnership of over 45 cities, states, and national health organizations U.S. population (see Appendix G) working to reduce U.S. population salt intake by 20% over 5 years by working with industry to set salt reduction targets that are designed to allow for gradual reductions in the sodium content of packaged and restaurant foods a Public Law 111-8, Joint Explanatory Statement: Division F—Labor, Health and Human Services, and Education, and Related Agencies Appro- priations, 2009. b Implemented or passed into law as of February 16, 2010. See Appendix J for more information. NOTE: d = day; g = gram; mg = milligram; tsp = teaspoon.

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TABLE B-2 Past Recommendations from the National Academies and the World Health Organization Target Population Date Program/Initiative/Report Title Recommendations/Initiatives/Actions (if specified) The National Academies 1970 Safety and suitability of salt for use in baby Infant food Recommended ≤ 0.25% salt be added to commercial baby food foods (NRC, 1970) manufacturers 1980 Toward Healthful Diets (NRC, 1980a) Use salt in moderation; adequate but safe intakes are considered to range between 3–8 g/d salt (1,200–3,200 mg/d sodium) 1980 Recommended Dietary Allowances, 9th ed. Estimated Safe and Adequate Daily Dietary Intake of sodium: 1,100– Adults (NRC, 1980b) 3,300 mg 1989 Recommended Dietary Allowances (NRC, Estimated minimum requirements for sodium of 500 mg/d Healthy persons 1989a) ≥ 10 years of age 1989 Diet and Health: Implications for Reducing Limit total daily intake of salt (sodium chloride) to ≤ 6 g, although Chronic Disease Risk (NRC, 1989b) ≤ 4.5 g would probably confer greater health benefits Limit use of salt in cooking and avoid adding it to food at the table Salty, highly processed salty, salt-preserved, and salt-pickled foods should be consumed sparingly 2005 Dietary Reference Intakes for Sodium Established Adequate Intake: (IOM, 2005) • 1.5 g/d for persons 9–50 y • 1.3 g/d for persons 51–70 y • 1.2 g/d for persons > 70 y Established Upper Limit: • 2.2 g/d for persons 9–13 y • 2.3 g/d for persons >13 y  continued

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TABLE B-2 Continued  Target Population Date Program/Initiative/Report Title Recommendations/Initiatives/Actions (if specified) 2010 Strategies to Reduce Sodium Intake (IOM, Recommended a coordinated approach to set standards for safe levels U.S. population 2010) of sodium in food using existing FDA authorities to modify the generally recognized as safe (GRAS) status of salt and other sodium- containing compounds Recommended a nationally organized campaign to educate the public about the risks of excess sodium intake and healthful food choices, build support for government and industry activities, and support consumers in making behavior changes to reduce sodium intake World Health Organization (WHO) 1990 Diet, Nutrition, and the Prevention of Upper limit 6 g/d salt Chronic Diseases (WHO, 1990) Lower limit not defined 2003 Diet, Nutrition, and the Prevention of < 5 g/d salt Chronic Diseases (WHO, 2003) NOTE: d = day; g = gram; mg = milligram; y = years.

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TABLE B-3 Past Recommendations from Health Professional Organizations Target Population Date Program/Initiative/Report Title Recommendations/Initiatives/Actions (if specified) American Heart Association (AHA) 1973 Diet and Coronary Heart Disease (AHA, Moderate sodium intake 1973) 1986 Dietary Guidelines for Healthy American Consume no more than 3,000 mg/1,000 kcal/d sodium Adults Adults (AHA, 1986) 1988 Dietary Guidelines for Healthy American Consume no more than 3,000 mg/d sodium Adults Adults (AHA, 1988) 1996 Dietary Guidelines for Healthy American Consume no more than 6 g/d salt (2,400 mg/d) Adults Adults (Krauss et al., 1996) 1998 Dietary Electrolytes and Blood Pressure Adults Consume ≤ 6 g/d salt (Kotchen and McCarron, 1998) 2000 Dietary Guidelines (Krauss et al., 2000) Limit salt intake to 6 g/d, ~100 mmol/d of sodium General population 2006 Diet and Lifestyle Recommendations Choose and prepare foods with little salt Adults and (Revision) for CVD Risk Reduction “In view of the available high-sodium food supply and the currently children over (Lichtenstein et al., 2006) high levels of sodium consumption, a reduction in sodium intake to 2 years of age 1,500 mg/d (65 mmol/d) is not easily achievable at present. In the interim, an achievable recommendation is 2,300 mg/d (100 mmol/d)” Information dissemination program  continued

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TABLE B-3 Continued 0 Target Population Date Program/Initiative/Report Title Recommendations/Initiatives/Actions (if specified) 2006 Alliance for a Healthier Generation Established voluntary nutrition guidelines (based on the 2005 Dietary (joint initiative of AHA and the William Guidelines and AHA’s 2006 Diet and Lifestyle Recommendations) for J. Clinton Foundation) (Alliance for a competitive school foods (e.g., foods in vending machines) as part of Healthier Generation, 2009) its goal to reduce prevalence of childhood obesity; leading industry groups have signed on American Medical Association 1979 Concepts of Nutrition and Health (Council Moderate intake of salt to less than 12 g/d (4,800 mg/d sodium) on Scientific Affairs, 1979) 2006 Report of the Council on Science and Recommended a stepwise, minimum 50% reduction in sodium in Public Health (Dickinson and Havas, 2007; processed foods, fast food products, and restaurant meals over Havas et al., 2007) the next decade; recommended that FDA revoke GRAS (generally recognized as safe) status of salt American Dietetic Association 2007 Nutrition Fact Sheets and web page (www. Provided sodium guidance on the meaning of sodium label claims and eatright.org) food purchasing or preparation techniques to reduce sodium intake American Public Health Association 2002 Policy Statement: Reducing sodium content Urged manufacturers to reduce the sodium content of processed foods in the American diet (APHA, 2002) by 50% over the next decade at a suggested rate of 5% per year

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American Institute for Cancer Research and World Cancer Research Fund 1997 Food, Nutrition, and the Prevention of Adults Limit salt from all sources to < 6 g/d Cancer: A Global Perspective (WCRF/ Limit consumption of salted foods and use of cooking and table salt AICR, 1997) 2007 Food, Nutrition, and the Prevention of Limit consumption of salt Cancer: A Global Perspective (WCRF/ Population average consumption of salt from all sources to be < 5 g/d AICR, 2007) (2,000 mg/d sodium) Proportion of the population consuming more than 6 g salt (2,400 mg sodium)/d should be halved every 10 years World Action on Salt and Health Annually World Salt Awareness Week (World Action The 2009 awareness week focused on the often high amount of since on Salt and Health, 2009) hidden salt in foods obtained and consumed outside the home, and 2008 highlighted the importance of adding less salt to food and the long- term health implications of eating a high salt diet World Hypertension League and World Action on Salt and Health Annually World Hypertension Day (World The 2009 day urged health experts and chefs to raise awareness of two since Hypertension League, 2009) “silent killers”: salt and high blood pressure 2005 NOTE: d = day; g = gram; kcal = calorie; mg = milligram. 

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 APPENDIX B REFERENCES AHA (American Heart Association). 1973. Diet and coronary heart disease. New York: American Heart Association. AHA. 1986. Dietary guidelines for healthy American adults: A statement for physicians and health professionals by the Nutrition Committee. Circulation 74:1465A-1468A. AHA. 1988. Dietary guidelines for healthy American adults. A statement for physicians and health professionals by the Nutrition Committee, American Heart Association. Circula- tion 77(3):721A-724A. Alliance for a Healthier Generation. 2009. The healthy schools program. http://www.healthier generation.org/schools.aspx?id=3275 (accessed February 2, 2008). APHA (American Public Health Association). 2002. Reducing sodium content in the American diet. http://www.apha.org/advocacy/policy/policysearch/default.htm?id=278 (accessed October 8, 2008). CDC (Centers for Disease Control and Prevention). 2009. Fiscal year 00: Justifi- cation of estimates for appropriation committees. http://www.cdc.gov/fmo/topic/ Budget%20Information/appropriations_budget_form_pdf/FY2010_CDC_CJ_Final.pdf (accessed April 14, 2010). Council on Scientific Affairs. 1979. American Medical Association concepts of nutrition and health. JAMA 242(21):2335-2338. CSPI (Center for Science in the Public Interest). 2005. Petition to reoke the GRAS status of salt, to set ceilings on the amount of sodium in processed foods, to require a health warning on packaged salt, and to reduce the daily alue for sodium. http://www.cspinet. org/salt/fda_salt_petition.pdf (accessed September 19, 2009). Derby, B. M., and S. B. Fein. 1995. Meeting the NLEA education challenge: A consumer research perspective. In Nutrition Labeling Handbook, edited by R. Shapiro. New York: M. Dekker. Pp. 315-353. Dickinson, B. D., and S. Havas. 2007. Reducing the population burden of cardiovascular disease by reducing sodium intake: A report of the Council on Science and Public Health. Archies of Internal Medicine 167(14):1460-1468. FNS (Food and Nutrition Service). 2008. USDA commodity foods: The healthy option. Wash- ington, DC: U.S. Department of Agriculture. FNS. 2010. HealthierUS school challenge. http://www.fns.usda.gov/tn/healthierus/index.html (accessed March 22, 2010). Havas, S., B. D. Dickinson, and M. Wilson. 2007. The urgent need to reduce sodium consump- tion. Journal of the American Medical Association 298(12):1439-1441. HHS (U.S. Department of Health and Human Services). 2000. Healthy People 00: Un- derstanding and improing health and objecties for improing health, Volume II, nd edition. 2nd ed. Washington, DC: U.S. Government Printing Office. HHS/FDA (Food and Drug Administration). 1973. Food label information panel. Federal Register 38(13):2126. HHS/FDA. 1982. GRAS safety review of sodium chloride; policy notice; solicitation of views. Federal Register 47(118):26590-26595. HHS/FDA. 1984. Food labeling, declaration of sodium content of foods and label claims for foods on the basis of sodium content. Federal Register 49(76):15510-15535. HHS/FDA. 1993a. Food labeling: Health claims and label statements; sodium and hyperten- sion; correction. Federal Register 58(61):17099-17100. HHS/FDA. 1993b. Food labeling: Health claims and label statements; sodium and hyperten- tion; final rule. Federal Register 58(3):2820-2849. HHS/FDA. 1993c. Food labeling: Mandatory status of nutrition labeling and nutrient content revision, format for nutrition label; final rule. Federal Register 58(3):2079.

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