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Strategies to Reduce Sodium Intake in the United States (2010)

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

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Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

TABLE B-1 Government Initiatives

Date

Program/Initiative/Report Title

Recommendations/Initiatives/Actions

Target Population (if specified)

White House Conference

1969

Conference on Food, Nutrition, and Health: Final Report (White House Conference, 1969)

Provided advice on the desirability of reducing sodium intake

Hypertensive individuals

 

 

Encouraged food processors to minimize the amount of salt in processed foods

Food processors

 

 

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, 2nd edition (Select Committee on Nutrition and Human Needs, 1977)

Decrease salt intake to about 5 g/d

All Americans

U.S. Department of Health and Human Services—Centers for Disease Control and Prevention (CDC)

2009

The Congressional Omnibus Appropriations Acta (2009) included language encouraging CDC to work with major food manufacturers and chain restaurants to reduce sodium content in their products and to submit to the Committee on 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

CDC plans to explore existing national and international public and private initiatives to reduce sodium in the food supply

In fiscal years 2009–2010, CDC plans to convene public and private stakeholders to build relationships and partnerships to investigate approaches for reducing sodium consumption

CDC will explore knowledge gaps, utilizing its data systems to analyze and release pertinent sodium related data (CDC, 2009)

Food manufacturers and chain restaurants

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

U.S. Department of Health and Human Services—Surgeon General

1979

Healthy People: Surgeon General’s Report on Health Promotion and Disease Prevention (Public Health Service, 1979)

Consume less salt; cook with only small amounts of salt, avoid adding salt at the table, avoid salty prepared foods

All Americans

1988

Surgeon General’s Report on Nutrition and Health (Public Health Service, 1988)

Reduce intake of sodium by choosing foods relatively low in sodium and limiting the amount of salt added in food preparation and at the table

All Americans

U.S. Department of Health and Human Services—Public Health Service

1980

Promoting Health and Preventing Disease: Objectives for the Nation (Public Health Service, 1980)

By 1990:

  • Reduce the average daily sodium ingestion (as measured by excretion) for 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

All Americans

1990

Healthy People 2000 (NCHS, 2001)

Increase % of persons preparing foods without adding salt from 43% (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%

All Americans

2001

Healthy People 2000 Review (NCHS, 2001)

During the mid-1990s, overall the percent of persons rarely or never using salt at the table ranged from 56–62%, and the % of persons regularly purchasing foods with reduced salt and sodium content was 19%

All Americans

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

Date

Program/Initiative/Report Title

Recommendations/Initiatives/Actions

Target Population (if specified)

2000

Healthy People 2010 (HHS, 2000)

Increase the percentage of persons who consume ≤ 2,400 mg/d sodium from baseline (21% based on the National Health and Nutrition Examination Survey [NHANES] 1988–1994) to 65% (only 13% met target in 2003–2004 [Public Health Service, 2008])

Persons 2 or more years of age

U.S. Department of Health and Human Services—National Heart, Lung, and Blood Institute (NHLBI), the National Institutes of Health

1972

National High Blood Pressure Education Program (NHLBI, 2010)

Cooperative effort among professional and voluntary health agencies, state 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

All Americans

1993

Working Group Report on Primary Prevention of Hypertension (National High Blood Pressure Education Program) (Whelton et al., 1993)

Reduce salt intake to no more than 6 g per day

All Americans

1995, 1999

Statement from the National High Blood Pressure Education Program Coordinating Committee (NHLBI, 1999)

Moderate salt and sodium intake

Establish 2,400 mg/d sodium as a national dietary goal

 

1996

Workshop: Implementing Recommendations for Dietary Salt Reduction: Where Are We? Where Are We Going? How Do We Get There? (NHLBI, 1996)

Develop public and professional education activities within the primary prevention campaign to convey the rationale for and benefits of lowering dietary salt/sodium for hypertension prevention to the appropriate target audiences

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

 

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

 

 

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 National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (NHLBI, 1997)

Reduce sodium intake to ≤ 100 mmol/d (2,400 mg sodium or 6 g sodium chloride)

 

2002

National High Blood Pressure Education Program (update of 1993 report) (NHLBI, 2002)

Reduce dietary sodium intake to no more than 100 mmol/d (approximately 2,400 mg of sodium or 6 g of sodium chloride)

All Americans

2003

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (NHLBI, 2004)

Reduce sodium intake to no more than 100 mmol/d (2,400 mg sodium or 6 g sodium chloride)

 

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

Date

Program/Initiative/Report

Title Recommendations/Initiatives/Actions

Target Population (if specified)

2005

Prevent and Control America’s High Blood Pressure: Mission Possible (NHLBI with CDC and the American Heart Association [AHA] as supporting partners; 22 states participated) (NHLBI, 2005)

Promoted awareness and education materials to help the public health community attract new partners and revitalize relationships with existing partners to fight high blood pressure

Persons at high risk for hypertension

 

States distributed materials to public health departments; hospitals and clinics; schools; senior centers; refugee centers; faith-based organizations; work sites; primary care practices; emergency medical service groups; state health benefit plans; and disease-related organizations, such as diabetes, kidney failure, and cancer groups

Low-SES (socioeconomic status) and minority populations

2006

NIH Radio (NIH, 2006)

Produced a broadcast-ready public service announcement about fighting high blood pressure through diet

All Americans

U.S. Department of Agriculture and U.S. Department of Health and Human Services (USDA/HHS)

1980

Dietary Guidelines for Americans (USDA/HHS, 1980)

Avoid too much sodium

“Most Americans”

1985

Dietary Guidelines for Americans (USDA/HHS, 1985)

Avoid too much sodium

“Most Americans … those who are already healthy”

1990

Dietary Guidelines for Americans (USDA/HHS, 1990)

Use salt and sodium only in moderation

Healthy Americans 2 or more years of age

1995

Dietary Guidelines for Americans (USDA/HHS, 1995)

Choose a diet moderate in salt and sodium. “The Nutrition Facts Label lists A Daily Value of 2,400 mg”

Healthy Americans 2 or more years of age

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

2000

Dietary Guidelines for Americans (USDA/HHS, 2000)

Choose and prepare foods with less salt

Healthy Americans 2 or more years of age

2005

Dietary Guidelines for Americans (USDA/HHS, 2005)

Consume < 2,300 mg/d of sodium (~1 tsp salt)

Choose and prepare foods with little salt, and consume potassium-rich foods, such as fruits and vegetables

Americans 2 or more years of age

 

 

Individuals with hypertension, African Americans, and middle-aged and older adults: Aim to consume no more than 1,500 mg/d of sodium, and meet the potassium recommendation (4,700 mg/d) with food

High-risk populations

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 of sodium chloride and potassium chloride as food ingredients (SCOGS, 1979)

Consumption of sodium chloride should be reduced

Guidelines should be developed for restricting salt in processed foods

The sodium content of processed foods should be labeled

 

1981

Initiative with NHLBI (Derby and Fein, 1995)

Educate the public about sodium

Encourage manufacturers to display the sodium content on food labels

 

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

Date

Program/Initiative/Report Title

Recommendations/Initiatives/Actions

Target Population (if specified)

1982

Rejected petitions requesting reclassification of salt’s status from “GRAS” (generally recognized as safe) to “food additive” and the addition of warning labels to highsodium foods and salt packets by deferring action on GRAS status of salt (HHS/FDA, 1982)

Deferred action pending assessment of the impact of

  • Sodium labeling regulations

  • Manufacturer efforts to voluntarily reduce salt

Indicated that a voluntary program would produce the desired results with less regulatory burden and affirmed that the food industry was in the best position to reduce sodium levels in processed foods and should be given a chance to do so

 

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

 

1993–2005

Nutrition Labeling Final Rules (HHS/FDA, 1993a,b,c, 1994, 2005)

Established a Daily Value (DV) of 2,400 mg for sodium labeling

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 in foods labeled as “healthy” (HHS/FDA, 2005)

Retained 1993 level of ≤ 480 mg sodium per serving; eliminated requirement that this level drop to ≤ 360 mg

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

 

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

2007

Public hearing in response to a 2005 petition (CSPI, 2005) requesting rulemaking regarding salt and a House of Representatives’ Committee on Appropriations 2005 statement encouraging the agency to focus on ways—both voluntary by the food industry and regulatory by FDA and USDA—to reduce salt in processed and restaurant foods (HHS/FDA, 2007a)

The petition specifically requested FDA to

  • revoke the GRAS status of salt

  • amend any prior sanctions for salt

  • require food manufacturers to reduce the amount of sodium in all processed foods

  • require health messages on retail packages of salt (0.5 oz.+); reduce the DV for sodium from 2,400 to 1,500 mg

Issues discussed—GRAS vs. food additive status:

  • Could a food additive regulation be constructed to prescribe limitations for uses of salt? If so, how?

  • 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?

 

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

Date

Program/Initiative/Report Title

Recommendations/Initiatives/Actions

Target Population (if specified)

2007

Advanced Notice of Proposed Rulemaking (ANPR): Nutrition Labeling (HHS/FDA, 2007b)

Requested comments on questions including:

  • Should the Daily Reference Value (DRV) for sodium be based on 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 (provides 15–20% of school lunch program foods)

Recommended specific sodium reductions for 10 commodity food categories in USDA’s Commodity Distribution Program: canned beef, pork, poultry, luncheon meat, refried beans, salmon, tuna, ready-to-eat cereals, ham, and carrots

Excluded many other products due to the assumption that school children would find modifications unacceptable (USDA, 1995)

Children consuming school meals

2004

HealthierUS School Challenge (encourages elementary, middle, and high schools to improve the nutrition content of foods provided to children and youth) (FNS, 2010)

Rewards changes in the school nutrition environment, including providing lower-sodium foods to all children and youth:

  • Gold, silver, or bronze recognition: Foods with ≤ 480 mg sodium per non-entrée or ≤ 600 mg sodium per entrée

  • Gold award of distinction: Non-entrées with ≤ 200 mg sodium and entrées with ≤ 480 mg

Children and youth consuming school meals

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

2007

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (provides vouchers to participants for the purchase of specific food items to meet nutritional needs) (USDA/FNS, 2007)

Requires that in certain food categories, foods must be lower in sodium or not have added sodium to qualify as a product that can be purchased with WIC vouchers

Low-income, nutritionally at-risk, pregnant and postpartum women; infants and children up to 5 years

2008

Commodity Distribution Program (FNS, 2008)

Plans to purchase low-sodium canned vegetables with the goal to reduce sodium levels of all canned vegetables to ≤ 140 mg per serving by school year 2010

Children consuming school meals

State and Local (Sodium Labeling Initiatives)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

 

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

Date

Program/Initiative/Report Title

Recommendations/Initiatives/Actions

Target Population (if specified)

Government/Non-government Organization Partnership

2009

National Salt Reduction Initiative (see Appendix G)

Partnership of over 45 cities, states, and national health organizations 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

U.S. population

aPublic Law 111-8, Joint Explanatory Statement: Division F—Labor, Health and Human Services, and Education, and Related Agencies Appropriations, 2009.

bImplemented or passed into law as of February 16, 2010. See Appendix J for more information.

NOTE: d = day; g = gram; mg = milligram; tsp = teaspoon.

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

TABLE B-2 Past Recommendations from the National Academies and the World Health Organization

Date

Program/Initiative/Report Title

Recommendations/Initiatives/Actions

Target Population (if specified)

The National Academies

1970

Safety and suitability of salt for use in baby foods (NRC, 1970)

Recommended ≤ 0.25% salt be added to commercial baby food

Infant food 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. (NRC, 1980b)

Estimated Safe and Adequate Daily Dietary Intake of sodium: 1,100–3,300 mg

Adults

1989

Recommended Dietary Allowances (NRC, 1989a)

Estimated minimum requirements for sodium of 500 mg/d

Healthy persons ≥ 10 years of age

1989

Diet and Health: Implications for Reducing Chronic Disease Risk (NRC, 1989b)

Limit total daily intake of salt (sodium chloride) to ≤ 6 g, although ≤ 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 (IOM, 2005)

Established Adequate Intake:

  • 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

 

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

Date

Program/Initiative/Report Title

Recommendations/Initiatives/Actions

Target Population (if specified)

2010

Strategies to Reduce Sodium Intake (IOM, 2010)

Recommended a coordinated approach to set standards for safe levels 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

U.S. population

World Health Organization (WHO)

1990

Diet, Nutrition, and the Prevention of Chronic Diseases (WHO, 1990)

Upper limit 6 g/d salt

Lower limit not defined

 

2003

Diet, Nutrition, and the Prevention of Chronic Diseases (WHO, 2003)

< 5 g/d salt

 

NOTE: d = day; g = gram; mg = milligram; y = years.

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

TABLE B-3 Past Recommendations from Health Professional Organizations

Date

Program/Initiative/Report Title

Recommendations/Initiatives/Actions

Target Population (if specified)

American Heart Association (AHA)

1973

Diet and Coronary Heart Disease (AHA, 1973)

Moderate sodium intake

 

1986

Dietary Guidelines for Healthy American Adults (AHA, 1986)

Consume no more than 3,000 mg/1,000 kcal/d sodium

Adults

1988

Dietary Guidelines for Healthy American Adults (AHA, 1988)

Consume no more than 3,000 mg/d sodium

Adults

1996

Dietary Guidelines for Healthy American Adults (Krauss et al., 1996)

Consume no more than 6 g/d salt (2,400 mg/d)

Adults

1998

Dietary Electrolytes and Blood Pressure (Kotchen and McCarron, 1998)

Consume ≤ 6 g/d salt

Adults

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 (Revision) for CVD Risk Reduction (Lichtenstein et al., 2006)

Choose and prepare foods with little salt

“In view of the available high-sodium food supply and the currently high levels of sodium consumption, a reduction in sodium intake to 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

Adults and children over 2 years of age

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

Date

Program/Initiative/Report Title

Recommendations/Initiatives/Actions

Target Population (if specified)

2006

Alliance for a Healthier Generation (joint initiative of AHA and the William J. Clinton Foundation) (Alliance for a Healthier Generation, 2009)

Established voluntary nutrition guidelines (based on the 2005 Dietary Guidelines and AHA’s 2006 Diet and Lifestyle Recommendations) for competitive school foods (e.g., foods in vending machines) as part of its goal to reduce prevalence of childhood obesity; leading industry groups have signed on

 

American Medical Association

1979

Concepts of Nutrition and Health (Council on Scientific Affairs, 1979)

Moderate intake of salt to less than 12 g/d (4,800 mg/d sodium)

 

2006

Report of the Council on Science and Public Health (Dickinson and Havas, 2007; Havas et al., 2007)

Recommended a stepwise, minimum 50% reduction in sodium in processed foods, fast food products, and restaurant meals over 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.eatright.org)

Provided sodium guidance on the meaning of sodium label claims and food purchasing or preparation techniques to reduce sodium intake

 

American Public Health Association

2002

Policy Statement: Reducing sodium content in the American diet (APHA, 2002)

Urged manufacturers to reduce the sodium content of processed foods by 50% over the next decade at a suggested rate of 5% per year

 

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

American Institute for Cancer Research and World Cancer Research Fund

1997

Food, Nutrition, and the Prevention of Cancer: A Global Perspective (WCRF/AICR, 1997)

Limit salt from all sources to < 6 g/d

Adults

 

Limit consumption of salted foods and use of cooking and table salt

 

2007

Food, Nutrition, and the Prevention of Cancer: A Global Perspective (WCRF/AICR, 2007)

Limit consumption of salt

Population average consumption of salt from all sources to be < 5 g/d (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 since 2008

World Salt Awareness Week (World Action on Salt and Health, 2009)

The 2009 awareness week focused on the often high amount of hidden salt in foods obtained and consumed outside the home, and highlighted the importance of adding less salt to food and the longterm health implications of eating a high salt diet

 

World Hypertension League and World Action on Salt and Health

Annually since 2005

World Hypertension Day (World Hypertension League, 2009)

The 2009 day urged health experts and chefs to raise awareness of two “silent killers”: salt and high blood pressure

 

NOTE: d = day; g = gram; kcal = calorie; mg = milligram.

Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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. Circulation 77(3):721A-724A.

Alliance for a Healthier Generation. 2009. The healthy schools program. http://www.healthiergeneration.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).

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Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
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Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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Suggested Citation:"Appendix B: Government Initiatives and Past Recommendations of the National Academies, the World Health Organization, and Other Health Professional Organizations." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
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Reducing the intake of sodium is an important public health goal for Americans. Since the 1970s, an array of public health interventions and national dietary guidelines has sought to reduce sodium intake. However, the U.S. population still consumes more sodium than is recommended, placing individuals at risk for diseases related to elevated blood pressure.

Strategies to Reduce Sodium Intake in the United States evaluates and makes recommendations about strategies that could be implemented to reduce dietary sodium intake to levels recommended by the Dietary Guidelines for Americans. The book reviews past and ongoing efforts to reduce the sodium content of the food supply and to motivate consumers to change behavior. Based on past lessons learned, the book makes recommendations for future initiatives. It is an excellent resource for federal and state public health officials, the processed food and food service industries, health care professionals, consumer advocacy groups, and academic researchers.

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