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Strategies to Reduce Sodium Intake in the United States
Past Recommendations for Food Industry Actionsand Point-of-Purchase Information
Many of the initiatives identified in Table 2-1 include recommendations that food processors voluntarily reduce the sodium content of their foods, market lower-sodium alternatives, and make information on the sodium content of their foods readily available at the point of purchase. More recently, calls have also been made for restaurants and other foodservice operations to do the same.
These earlier efforts focusing on the food industry were supported and heightened by the results from a small but frequently cited study published in 1991 (Mattes and Donnelly, 1991). It found that processing-added sodium provided more than 75 percent of the total sodium intake of individuals. Another 5 percent was attributable to salt added during cooking and 6 percent was due to salt added by consumers at the table. Subjects had control over the amount of salt added during cooking; during the 7-day study period they ate fewer than three meals away from home and prepared their own meals at home. Thus, the amount of sodium directly under the control of the individual was shown to be relatively small, and most dietary sodium was shown to come from sources beyond consumers’ direct control. Consistent with this, Engstrom et al. (1997) reported that even with a 65 percent reduction in discretionary salt use (i.e., from 1,376 mg/d sodium in 1980–1982 to 476 mg/d in 1990–1992), average daily sodium intake remained > 3,000 mg/d—a level in excess of the Dietary Guidelines forAmericans goal of < 2,300 mg/d.
As mentioned previously, these data put in motion a change in the emphasis of recommendations from encouraging consumers to reduce or avoid salt use at the table and in home food preparation to an emphasis on encouraging food processors to reduce the sodium content of their products. Calls for point-of-purchase information about the sodium content of foods increased. When the 1990 Nutrition Labeling and Education Act (NLEA) was enacted, the Food and Drug Administration (FDA) ensured that sodium was one of the nutrients that must be declared on the labels of processed foods.
At the same time that requests were being made to members of the food industry to voluntarily reduce sodium in their products to assist consumers in lowering their sodium intake, concerns were being raised about the safe use of salt in foods, specifically the levels of salt added by manufacturers. An independent expert panel evaluating this topic in 1979 (SCOGS, 1979) recommended, among other things, that FDA develop guidelines for the safe use of salt in processed foods. As described in more detail in Chapter 7, FDA deferred action on these recommendations, suggesting that the largely voluntary 1975 sodium-based nutrition labeling regulations coupled with