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Index

A

Acrylamide formation, 102

Adequate Intakes (AIs), 10, 119-120, 126, 127, 226, 227, 269-270, 288-289, 325, 327, 344, 347, 413, 420-423, 428, 430, 432

Adolescents, 21, 197, 267

Adults.

See also Age

intakes of sodium, 59-60

middle-age and older, risks to, 17, 20-21, 23, 35, 132, 136, 219, 265, 341

Tolerable Upper Intake Level, 18

Advertising

defined, 325

nutrient content and health claims, 52-53, 54, 55, 63, 168, 170-171, 341

outreach opportunities, 267-268

private label products, 166

product development process, 164, 166

regulation of, 224, 268, 341

Aeromonas hydrophila, 96

African Americans, 17, 35, 62, 119, 130, 131, 132, 135-137, 191, 219, 413, 426, 451

Age.

See also Adolescents;

Adults;

Children and youth, 60, 61, 132

intakes by, 5, 6, 57, 58, 59, 78-79, 123-124, 125-128, 130, 131, 132-133, 138, 141, 358, 418-433, 438-441

and preference for salt, 78-79

sodium intake density by, 6, 58, 59, 129, 138, 139, 424-425

Alcoholic beverages, 21, 61, 187, 326, 462

American Dietetic Association (ADA), 30, 32-33, 34, 350

American Heart Association (AHA), 30, 32, 34, 340, 349-350, 443, 450

American Institute for Cancer Research (AICR), 32-33, 351

American Medical Association (AMA), 30, 32-33, 34, 350, 443, 450

American Public Health Association (APHA), 30, 32-33, 34, 350, 443, 450

American Recovery and Reinvestment Act, 247

American Society of Hypertension, 450

Amiloride, 75, 76

Ammonium bicarbonate, 102

Angiotensin-converting enzyme, 278

Angiotensin receptor blockers, 278

Anticaking agents, 99

Antioxidants, 74, 113

Aramark, 176, 182

Arcobacter, 96

Armed Forces Recipe Service, 189

Aspartame, 85, 222, 275, 326

At-home foods



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OCR for page 473
Index A and preference for salt, 78-79 sodium intake density by, 6, 58, 59, 129, Acrylamide formation, 102 138, 139, 424-425 Adequate Intakes (AIs), 10, 119-120, 126, Alcoholic beverages, 21, 61, 187, 326, 462 127, 226, 227, 269-270, 288-289, American Dietetic Association (ADA), 30, 325, 327, 344, 347, 413, 420-423, 32-33, 34, 350 428, 430, 432 American Heart Association (AHA), 30, 32, Adolescents, 21, 197, 267 34, 340, 349-350, 443, 450 Adults. See also Age American Institute for Cancer Research intakes of sodium, 59-60 (AICR), 32-33, 351 middle-age and older, risks to, 17, 20- American Medical Association (AMA), 30, 21, 23, 35, 132, 136, 219, 265, 341 32-33, 34, 350, 443, 450 Tolerable Upper Intake Level, 18 American Public Health Association Advertising (APHA), 30, 32-33, 34, 350, 443, defined, 325 450 nutrient content and health claims, 52- American Recovery and Reinvestment Act, 53, 54, 55, 63, 168, 170-171, 341 247 outreach opportunities, 267-268 American Society of Hypertension, 450 private label products, 166 Amiloride, 75, 76 product development process, 164, 166 Ammonium bicarbonate, 102 regulation of, 224, 268, 341 Angiotensin-converting enzyme, 278 Aeromonas hydrophila, 96 Angiotensin receptor blockers, 278 African Americans, 17, 35, 62, 119, 130, Anticaking agents, 99 131, 132, 135-137, 191, 219, 413, Antioxidants, 74, 113 426, 451 Aramark, 176, 182 Age. See also Adolescents; Adults; Children Arcobacter, 96 and youth, 60, 61, 132 Armed Forces Recipe Service, 189 intakes by, 5, 6, 57, 58, 59, 78-79, 123- Aspartame, 85, 222, 275, 326 124, 125-128, 130, 131, 132-133, At-home foods 138, 141, 358, 418-433, 438-441 

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 INDEX calories, 48, 49, 145, 197-198 Beans and legumes, 110, 111, 142, 143, characterizing sodium in, 141-145 247, 328, 344, 383, 400, 434, 435, consumer awareness and behavior, 17, 437 44-45, 191 Beverages, 50-51, 94, 114-115, 141, 143, defined, 415 159, 170, 174, 175, 177, 184, 195, intakes of sodium from, 2, 35, 36, 44- 248, 402, 412, 437, 460, 462. See 45, 48-49, 82-84, 123, 124, 133, also Water 141, 143-145, 411, 412, 414-415, Bleaching agent, 99 418-419, 442 Body mass index, 21, 61, 326 mixed sources, 49 Bone health, 30, 77 portion size and, 48, 197-198 Botulism, 96, 107 preparation time considerations, Breads. See Bakery/baked goods 196-198 Breakfast cereals, 103-104, 141, 142, 159, sodium intake density, 45-46, 47, 49-50, 242, 344, 360, 364, 377, 435, 438, 143-144, 145, 414 439, 441, 442 At-risk subpopulations British Heart Foundation, 135 defined, 17, 132 Buffering agents, 99 intakes, 119, 132-133, 135-136, Burger King, 175, 182 432-433 size of, 119 C targeting, 62 Australia, 101 Caffeine, 73 Away-from-home foods. See also Calcium Restaurant/foodservice operations coronary artery scores, 23 calories, 48, 49, 145, 197-198 deficiency and salt intake, 77 characterizing sodium in, 141-145 health claims, 228 consumption trends, 173, 196-198 leavening agents, 102, 104 defined, 415 nutrient content claims, 53, 457 intakes of sodium from, 48-49, 141, salt substitutes, 97, 405, 406 143-145 taste receptor, 75-76 portion size and, 48, 197-198 and water hardness, 133 sodium intake density, 45-46, 47, 49-50, WIC qualifying foods, 188 143-144, 145, 414 Calcium acid pyrophosphate, 102, 104 Calcium chloride, 97, 405 Calcium diglutamate, 406 B Calcium lactate, 406 Bacillus species, 96, 105 Calcium phosphates, 102 Bakery/baked goods California, 345, 450, 460-461 intakes of sodium from, 141, 142, 144, Calories 439, 440, 441 advertising positive claims, 53, 54, 55 iodine content, 276, 277 at-home vs. away-from-home labeling, 242 consumption, 48, 49, 145, 197-198 reduced-sodium products, 82, 159, 170, consumer concerns about, 44, 179, 194 171, 239, 243, 245, 363 defined, 326 salt substitutes, 405 industry concerns about, 192 sodium additives and their functions, 94, label information, 8, 43, 223, 229, 268- 97, 104-105 269, 457 sodium content of, 82, 100, 105, 236, menu information, 224, 232, 270-271, 360, 435, 442 459-466 target sodium reductions, 364, 375-376 restaurant/foodservice items, 173, 179, value of shipments, 155 224, 232, 270-271, 459-466

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 INDEX school meals, 186 public education, 267, 268, 295, 340 sodium intake relationship, 6, 21, 45- recommended strategies for, 11-12, 278, 46, 47, 49-50, 59, 128-129, 130, 294-295 137-140, 141-142, 143, 145, 266, sodium reduction activities, 336 307-308, 309, 314, 315 State Heart Disease and Stroke surveys of intakes, 411 Prevention Program, 267, 293 Campbell Soup Company, 34, 168, 170, summary of past activities and 171, 237 recommendations of, 32-33, 336, Canada 340 food industry characteristics, 155, 156, surveys, see National Health and 157, 158 Nutrition Examination Survey hyperkalemia, 279 Cereal. See Breakfast cereals; Grains and intakes of sodium, 358 grain products sodium reduction initiatives, 241, 243, Characterizing sodium in food supply 358-359 contributions by food category, 140-147, Canadian Community Health Survey, 358, 414-415 359 disappearance data, 55-56, 145-146 Canadian Heart Foundation, 135 identifying food sources, 140-145 Cancer, 30, 53, 340, 351 market basket study, 146-147; see also Carbohydrates, 108, 223, 224, 232, 271, Total Diet Study 459, 460, 462, 463, 464, 465 national food composition databases, CARDIA study, 136-137 137, 145, 147, 148, 295-296, 409, Carrageenan, 109 412 Categories of foods. See also specific prepared at home vs. away from home, 141-145 categories characterizing sodium contributions by, Chartwells School Dining Services, 182 140-147, 414-415 Child and Adult Care Food Program, 185 FDA standardization of, 299, 445, 446 Children and youth. See also Adolescents; functions of sodium additives by, Infants 103-115 advertising targeted at, 268 intakes of sodium by, 122, 140-141, AI, 120, 126 142-143, 414-415, 434-437 blood pressure levels, 21, 23, 60, 78 label claims by, 50-51 fast food consumption, 197 GRAS status modification framework, genesis of hypertension, 23 298-301 intakes and intake density of sodium, 5, menu items, 448-449 6, 58, 59, 123, 125, 126, 129, 130, new product introductions by, 159 138, 358, 418-425, 430-431 portion sizes differences by, 48 international trends, 358 preservative uses of sodium by, 105, interventions targeting, 35, 186-187, 106, 110, 112, 114 200, 268, 344 target salt reductions by, 242, 370-403, preference for salt, 24, 78-79, 81 446 public health concerns about, 127 UK framework, 241, 245, 298, 299, recommendations for, 349 370-403, 444-445, 446, 448-449 reporting intakes of, 121-122, 130 USDA standardization of for packaged restaurant menu items, 182 foods, 445 school breakfast and lunch programs, Center for Science in the Public Interest, 47, 184-187, 344 34, 169 sodium-to-calorie intake, 130 Centers for Disease Control and Prevention sources of sodium, 103, 418-421 (CDC), 18, 119 UL, 127, 358 Division of Heart Disease and Stroke WIC program, 34, 131, 184, 185, 188, Prevention, 267 252, 290, 345, 413, 430

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 INDEX China, 68, 136, 155 competing messages about other Cholesterol, 7, 41, 43, 44, 52, 55, 226, 228, nutrients, 7, 191, 266 265, 269, 327, 409, 457, 463, 465 coordinated messaging, 199-201, 263- Clostridium botulinum, 96, 107, 112, 275 264, 265-266, 292-293 Clostridium perfringens, 96 core message, 37 Commodity Distribution Program, 34, 185- design of, 200-201 186, 252, 344, 345 health communication campaigns, 35, Commodity Improvement Council, 186 62, 195, 199-201, 264-265 Commodity Supplemental Food Program, industry efforts, 30, 34, 168, 170-172, 185 181-183 Compass Group, 176, 182 international initiatives, 242 ConAgra, 156, 182 menu planning tools, 31, 34, 365 Condiments, 94, 110, 141, 142, 143, 159, national focus, 263-268, 292-293 436 nutrition labeling strategies, 42-44, 191, Confections, sweets, and desserts, 113-114, 201-202, 268-271 141, 142, 155, 159, 177, 388, 389, online health/nutrition information sites, 396-397, 436 34, 171-172, 181-183 Congressional Omnibus Appropriations outcomes of, 6-7, 37-45, 62-63, 146, 191 Act, 33, 336 outreach opportunities and tools, 266- Consolidated Appropriations Act of 2008, 268, 309 18 point-of-purchase information, 4, 24, Consumer awareness and behaviors 25, 26, 29, 36-37, 42, 61, 168, 172, at-home use of salt, 17, 44-45, 191 187, 193, 223, 225, 232, 236, 240- economic theory applied to, 193-198 241, 268-273, 293, 459, 461 food choice behavior, 192-193 public health messages and campaigns, food environment and, 62-63, 153, 190- 30, 191 204, 236 strategies, 264-265 food preparation time and, 194, target population, 35, 191 196-198 Consumer theory, 194-196 monitoring, 280 Consumption of salt/sodium. See Intakes of national focus, 263-268 sodium/salt nutrients other than sodium, 41, 43, 44, Content. See Sodium content of food 179, 194 Continuing Survey of Food Intakes by nutrition label understanding and use, Individuals, 48, 49, 197-198 42-44, 50-51, 191, 199, 223, 225, Culinary Institute of America, 181 265, 268 perceptions of intake, 38-40, 146, 201, D 236, 269 personal importance of avoiding sodium, Daily Reference Value, 227, 344 40-41 Daily Value for sodium, 10, 218, 225-228, and portion size, 48 269-270, 288-289, 327, 342, 366- social ecological model, 264, 293 367, 457 sodium/health relationship, 38-40, 191, Dairy foods 195, 198-199 butter, 108, 109, 242, 360, 381, 382, strategies to support changes in, 190- 397, 436 192, 263-273, 291-294 cheese, 80, 93-94, 96, 97-98, 100, 102, sustainability of interest, 63 108-109, 112, 113, 140, 141, 142, value associated with food and, 194-196 143, 144, 180, 182, 186, 242, 275, warning labels and, 201-202 308, 360, 364, 375, 378-381, 384, Consumer education 386, 387, 390, 405, 434, 436, 438, behavior change models, 264, 293-294 439, 440, 441, 442, 449

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 INDEX economic value of processed foods, 155 Dietary Reference Intakes, 18, 125, 219, functions of sodium in, 97-98, 100, 102, 227, 274, 327, 344, 347, 423. See 108-109, 112, 113 also Adequate Intakes, Estimated milk, 51, 101, 109, 113, 114, 141, 436, Average Requirement; Tolerable 438 Upper Intake Level new product introductions, 159 Dietary sources of sodium, 1-2. See also other products, 108, 109, 143 Levels of sodium in food supply; sodium content of, 100 Menus and menu items; Processed Delaware, 451, 462 foods Denny’s, 182 intake estimates by, 125-129, 137, Density of sodium intake 140-145 age and, 6, 58, 59, 129, 138, 139, non-salt preservatives, 92, 94 424-425 Dietary supplements, 122, 123, 124, 134, at-home vs. away-from-home, 45-46, 47, 187, 276, 410, 411-413, 415, 419 49-50, 143-144, 145, 414 Disappearance data, 55-56, 145-146 calculation, 148 District of Columbia, 451, 462 defined, 6, 45, 129 Dough-conditioning agents, 97, 98, 99, 101, gender and, 6, 58, 59, 129, 130, 138, 102, 104, 105, 112 139, 424-425 meeting dietary guidelines, 59, 63, 139, E 266 portion size and, 47, 48, 198 Economic Research Service, 57 sodium-to-calorie correlation values, Economic theory 130 consumer value associated with food, survey comparisons using, 58 194-196 trends over time, 6, 57, 58, 59, 128-129, household value associated with food 137-140, 144, 238 preparation, 196-198 Diabetes, 30, 278, 340 and sodium intake reduction, 193-198 Dicalcium phosphate, 102 Education. See Consumer education Diet and Health Knowledge Surveys, 39-40, Emergency Food Assistance Program, 185 41, 43, 44, 201 Emulsifying agents, 98, 99, 101-102, 104- Dietary Approaches to Stop Hypertension 105, 106, 109, 110, 381 (DASH) feeding trials, 136, 237, Emulsions, 84, 85, 86, 101 327 Energy intakes. See Calories Dietary Guidelines Advisory Committee, 20, Environment. See Food environment 23, 24 Epithelial sodium channels, 75-76, 328 Dietary Guidelines for Americans Estimated Average Requirements, 226, 227, at-risk populations defined, 17, 132 328 defined, 327 European Union, 155, 241, 245, 359. See linking health messages to, 263, 266, also indiidual countries 292, 338, 350 Exeter-Andover study, 204 military adherence to, 189 revision, 310, 327 sodium intake densities and, 59, 63, F 139, 266 sodium recommendations, 1, 3, 6, Farm Act legislation, 246, 247 17, 18, 31-32, 36, 47, 56, 59-60, Fast food. See also Restaurant/foodservice 62, 119, 123, 124, 132, 227, 310, oerations 340-341 children’s consumption of, 197 defined, 46, 331

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 INDEX layering of high-salt items, 308 importance in food acceptance, 2, 18, menu planning concerns, 178-179 69-71 monitoring, 147 research needs, 82 nutrition disclosure, 460 substitutes for salt, 84 portion sizes, 48, 198 taste as synonym for, 69 recommended sodium reductions, 350 Florida, 462-463 regulation of, 261 Folic acid supplementation, 63, 203, sales, 175, 176 254-255 sodium content of, 42-43, 101, 237-238 Food Additives Amendment, 214 sodium intake densities of foods, 46, Food and Agriculture Organization, 357 143, 144, 145, 147 Food and Drug Administration (FDA), 18 Fat, 44, 50, 52, 159, 186, 223, 228. See categories for packaged foods, 299, 445, also Saturated fats; Total fats; Trans 446 fats Daily Values, 10, 218, 225-228, 269- Federal Food, Drug, and Cosmetic Act, 8, 270, 288-289, 327, 342, 366-367, 13, 214, 222 n.14, 223, 230, 261, 457 286-287, 303, 459 Food Labeling and Package Survey, 12, Federal food programs. See also indiidual 50, 280, 295 food safety regulations, 8, 9, 12-13, 15, departments and agencies leveraging sodium reduction in, 252- 36, 164, 169, 214, 215-221, 223, 253, 290-291 254, 255, 256, 259, 260-261, 262, military, 175, 176, 177, 184, 185, 188- 275, 277, 286-287, 298, 303, 305- 189, 252, 290 307, 310, 342, 343, 348, 350; see National School Lunch Program and also GRAS status School Breakfast Program, 184-187 funding for, 311 SNAP, 131, 184, 185, 187, 188, 252, guidance for small companies, 275 290, 413, 430 Health and Diet Surveys, 7, 39-41, 44 WIC, 34, 131, 184, 185, 188, 252, 290, labeling requirements, 10, 33, 36-37, 345, 413, 430 42, 50, 173, 222-224, 225-226, 227, Federal Trade Commission (FTC), 12, 52, 228-229, 230-232, 239, 268-269, 224, 268, 295 273, 288-289, 301, 303, 338, 341, Federation of American Societies for 342; see also Nutrition labels/labeling Experimental Biology, 217 recommended strategies for, 8, 10, 12, Feeding Infants and Toddlers Study (FITS), 13, 15, 254, 255, 256, 259, 286-289, 127, 128 293, 295, 299, 305-306, 310 Fermentation, 92, 93-94, 97, 104, 110, 111, summary of past activities and 328 recommendations of, 30, 32-33, Fiber, dietary, 43, 44, 50, 53, 224, 228, 341-344 232, 270-271, 457, 459, 461, 463, Total Diet Study, 12, 38, 103, 112, 114, 465 145, 146-147, 277, 280, 295, 359 Finland, 239, 241, 242-243, 244, 359-361 USDA liaison with, 13 Finnish Heart Association, 360 Food and Drug Administration FINRISK survey, 360 Modernization Act, 230 Fish. See Seafood products Food and Drugs Act of 1906, 214 Flavor. See also Taste Food and Nutrition Service, 184 combining flavorings, 70, 84 Food composition databases, 137, 145, 147, cooking techniques and, 70 148, 295-296, 409, 412 effects of salt on, 72-74, 82 Food, Conservation, and Energy Act, enhancing agents, 5, 67, 73, 76, 85, 87, 246-247 98, 99, 103-106, 109, 110, 112-114, Food Distribution Program on Indian 168, 214, 220, 251, 260-261, 271, Reservations, 185 289, 307, 312, 313, 329, 406, 407

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 INDEX Food environment. See also Processed foods multiple-hurdle methods, 92-93, 97, consumer interactions with, 62-63, 153, 106, 112 190-204, 236 N-nitrosamines, 107 effectiveness of changes to, 254-255 predictive models for new formulations, 97 federal food programs, 184-189 reformulation challenges, 95-97, 102, framework, 153-154 164-165, 274-275 health behavior change embedded in, shelf-life testing, 164, 275 202-204 United Kingdom, 95-96, 274-275 manufacturing and retailing, 154-173 Food selections, changes in, 17 restaurant/food service foods, 173-184 Food Stamps. See Supplemental Nutrition state and local governments, 189-190 Assistance Program Food Guide Pyramid, 338 Foodservice. See also Fast food; Food Food industry. See also Processed foods; industry; Menus and menu items; Restaurant/foodservice operations Restaurants; School foods consumer education, 30, 34, 168, 170- defined, 173-174 172, 181-183 France, 68, 241, 243, 245, 361-362 defined, 1, 24, 26 Fresh Fruit and Vegetable Program, 185 interest in developing lower sodium Fruits and fruit products, 21, 30, 63, 71, products, 8, 29, 50, 61, 63, 161 94, 105, 110, 111, 114, 115, 140, online health information sites, 34 141, 143, 155, 159, 179, 181, 184, past recommendations for actions by, 185, 192, 196, 197, 224, 247, 266, 36-37 308, 315, 327, 328, 341, 376, 388, point-of-purchase information about 389, 437 sodium, 4, 24, 25, 26, 29, 36-37, 42, Functions of sodium additives in foods. 61, 168, 172, 187, 193, 223, 225, See also Physical properties of food; 232, 236, 240-241, 268-273, 293, Preservation of foods 459, 461 beverages, 94, 114-115 recommended strategies for, 10, 13, confections, 113-114 287-288 dairy foods, 97-98, 100, 101, 102, 108- research funding, 168, 169 109, 112, 113 response to public health initiatives, 4, fruits, vegetables, beans, and legumes, 25, 36-37, 237-238 94, 105, 110-111, 112, 114, 115 United Kingdom, 244-245, 364-365 grains, 103-105 voluntary reduction of sodium, 1, 4, 7, mixed dishes, 111-112 10, 13, 25, 26, 29, 36, 168-170, 242, muscle foods, 94, 95, 96, 97, 98, 100, 287-288 101, 102, 105, 106-107, 112 Food Labeling and Package Survey, 12, 50, research needs, 100, 101 280, 295 sauces, gravies, stocks, salad dressings, Food safety. See also GRAS status; and condiments, 96, 98, 110, 112 Preservation of foods; Regulation savory snacks, 97, 113 acrylamide formation, 102 and sodium content of similar foods, emerging technologies, 96, 97, 251-252 100-101 FDA authority, 8, 9, 12-13, 15, 36, 164, 169, 214, 215-221, 223, 254, 255, G 256, 259, 260-261, 262, 275, 277, 286-287, 298, 303, 305-307, 310, Gender 342, 343, 348, 350 and hypertension, 60, 61, 432 GRAS options, 218-222, 275 intakes of sodium by, 5, 57, 58, 59, 123, microbial growth prevention, 91-93, 94, 124, 126, 128, 135-136, 138, 141, 95-96, 97, 105, 106, 109, 110, 112, 418-421, 432-433, 438-441 229, 251-252, 275, 314, 382, 391

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0 INDEX sodium intake density by, 6, 58, 59, 129, prior-sanctioned uses of salt and, 220- 130, 138, 139, 424-425 221, 261 General Mills Inc., 34, 156, 170, 171 process to alter or revoke GRAS status, Glucono-δ-lactone, 102 219-221 Glutamic acid, 84, 329 rationale for modification, 253, 254-255 Government recommendations, 8-9, 10-13, 286-287 initiatives, see State and local restaurant/foodservice menu items, 10, governments; indiidual federal 230-231, 259-260, 261, 286-287, 304-305 departments and agencies food programs, see Federal food safety-based options, 218-222, 275 programs; State and local sodium-containing compounds other governments than salt, 287 public-private partnerships, 11, 15, 19, sodium enhancement solutions, 220, 32-33, 263, 288, 291, 293, 307, 309 260-261 Government Accountability Office (GAO), stepwise approach, 253-254, 255-257, 187, 218 286, 301-303 Grains and grain products. See also Bakery/ Gravies, 110, 112, 142, 436 baked goods Grocery Manufacturers Association, 273 breakfast cereals, 103-104, 141, 142, Guiding Stars Licensing Company, 444 159, 242, 344, 360, 364, 377, 435, 438, 439, 441, 442 H functions of sodium additives, 103-105 intakes of sodium from, 140, 141, 142, Harvard School of Public Health, 181 434, 435, 438, 442 Health and Diet Surveys, 7, 39-41, 44 iodine levels, 277 Health behavior. See also Consumer new products, 181 awareness and behaviors pasta, 104, 105, 140, 141, 142, 159, beliefs and attitudes, 199 182, 383, 385, 394, 434, 435, 438, communication campaigns, 35, 199-201 439, 440, 441, 442 embedded in food environment, 202-204 rice, 72, 103, 104, 105, 112, 142, 159, environmental barriers, 199 246-247, 384, 385, 395, 396, 434, intention to change, 198-199 435, 439, 442 labeling/disclosure strategies, 201-202 sodium content, 103, 104, 105, 265 perceived norms, 199 value of shipments, 155 self-efficacy, 199, 201 whole grains, 103, 181, 184 theory applied to sodium intake GRAS status reduction, 198-199 alteration or revocation process, 219- Health belief model, 198 221, 262 Health Canada, 358 exemption approach, 303-304 Health literacy, 61 food category framework, 298-301 HealthierUS School Challenge, 34, 186-187, implementation of standards, 15, 221, 344 298-307 Healthy People, 337, 338, 410, 411-412 labeling options, 222, 301-303 Heart disease, 1, 20, 21, 22, 23, 39, 40, 53, modification, 169, 253-262, 298-307 136-137, 191, 199, 200-201, 267, monitoring and evaluation system, 293, 326, 327, 349, 357, 362-363 257-259 Historical context for salt use, 68, 91, 214 overview, 216-218 Home. See At-home foods petitions for reclassification, 217-218, Household Food Consumption Surveys, 409 342 Household production theory, 196-198 potential for changes, 253-262, 303-304 Hyperkalemia, 278, 279, 329

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 INDEX Hypertension GRAS status modification, 298-307 age and, 60, 61, 132 monitoring of, 255 behavior change interventions, 199, outreach to consumers, 3, 309 293-294 time line, 310 consumer awareness of sodium/salt Incentives to lower sodium relationship to and health risks of, agricultural subsidies, 246-247 39-40, 62, 191, 264-265 awards and recognition, 186-187, 344 cost-effectiveness of sodium reductions, cap and trade system, 246, 249-250 21-22, 311 effectiveness of, 187 DASH Diet, 136, 237, 327 for food program participants, 290-291 deaths, 21 label content and health claims, 29, 45, definition, 60-61, 329, 413 50, 161, 224, 226, 240, 270, 271- dietary guidelines for persons with, 17, 272, 289, 343 119, 132, 219, 341 point-of-purchase, 187, 271-273 dose-response relationship, 23 restaurant/foodservice operations, 273, gender and, 60, 61, 432 290-291 health consequences, 1, 20, 21 in stepwise approach, 4, 25, 308 incidence, 17, 20, 35 tax credits, 247-248 income and, 61 tax on foods, 5, 246, 248-249 intakes by at-risk groups, 132, 432 Income, intakes by level, 131 international policies, 358 Indiana, 463 INTERSALT study, 135-136 Individuals, intakes by, 56-59 label health claims and advertising, 50, Industry. See Food industry 53, 230, 231, 289 Infants lifetime risk statistic, 21-22 intakes of sodium, 127-128 messages to consumers, 35, 61, 191, salt in baby foods, 347 264-265, 292 salt preference, 24, 78 outreach opportunities, 267 Initiatives addressing sodium, by year and prevalence, 20-21, 37, 60-61, 62 sponsor, 32-33 prevention interventions and reports, Institute of Medicine (IOM), 20, 30, 32-33, 203, 338, 340, 341, 351 119-120, 274 progressive nature of, 23 Intakes of sodium/salt. See also Density of race/ethnicity and, 61, 132 sodium intake; Monitoring sodium risk factors, 20, 60, 61 intakes salt substitutes and, 278 age and, 5, 6, 57, 58, 59, 78-79, 123- seriousness of public health problem, 124, 125-128, 130, 131, 132-133, 20-22 138, 141, 358, 418-433, 438-441 societal and medical savings of reducing AIs, 10, 119-120, 126, 127, 226, 227, hypertension, 22 269, 270, 288-289, 325, 327, 344, surveillance, 409 347, 413, 420-423, 428, 430, 432 trends, 6, 7, 20-21, 60-61, 62 at-risk subpopulations, 119, 132-133, World Hypertension Day, 33 135-136, 432-433 average daily, 1, 122 calcium deficiency and, 77 I calorie intakes and, 6, 21, 45-46, 47, 49-50, 59, 128-129, 130, 137-140, Ice cream, 108, 109, 142, 436 141-142, 143, 145, 266, 307-308, Implementation of strategies 309, 314, 315 content changes in processed foods and CARDIA study, 136-137 menu items, 2-3, 307-309 by category of foods, 122, 140-141, funding, 310-311 142-143, 414-415, 434-437

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 INDEX characterizing sodium in food supply, subpopulations of interest, 129-133, 140-147, 414-415 413 consumer awareness, 38-40, 146, 201, from supplements (dietary), 122, 123, 236, 269 124, 134, 410, 411-413, 415, current, U.S. population, 17, 20, 122- 419 127, 410-413 table salt, 2, 82-84, 123, 124, 133, 411, estimating, 121-122, 409-415 412, 418-419 food composition databases, 137, 145, total, all sources, 47, 123, 420-421 147, 148, 409 trends over time, 5-8, 17, 56-59, 136, food sources, 59, 119, 122, 123, 124, 137-140, 236, 414 125-129, 134, 137, 140-145, 411, ULs, 413, 420-421, 432-433 418-419, 426-433, 438-441 underreporting/underestimation, 57, gender and, 5, 57, 58, 59, 123, 124, 121-122, 136, 137, 410 126, 128, 135-136, 138, 141, 418- urine analysis measures of, 134-137, 421, 432-433, 438-441 139-140 home vs. away from home, 2, 35, 36, water sources, 123, 124, 133-134, 411 44-45, 48-49, 82-84, 119, 123, 124, INTERMAP, 136 132-133, 135-136, 141, 143-145, International Food Information Council, 41 411, 412, 414-415, 418-419, 432- International initiatives. See also indiidual 433, 442 countries income and, 131, 413, 430-431 components of, 241, 242, 243-244 by individuals, 56-59 and intakes of sodium, 242, 244, 245, INTERMAP study, 136 358, 359, 360-361, 363, 367-368 international, 242, 244, 245, 358, 359, nutrition labeling, 159, 243-244, 245, 360-361, 363, 367-368 246, 360, 362, 363 INTERSALT study, 135-136 scope of past activities, 30 levels of sodium in foods and, 59 International Society on Hypertension, market basket study, 146-147 135 measurement approaches, 55-60, 122 INTERSALT study, 135-136, 329 medications, 122-123 Iodine, 14, 148, 258, 259, 275-278, 281, NHANES analysis, 45, 47, 49, 56-59, 329 119, 120, 121, 122-133, 135, 136, Ireland, 243, 362-363 137-140, 147, 410-413 Irish Heart Foundation, 363 nonfood sources, 122, 123, 124, 133- Iron, 44, 107, 186, 188, 228, 457 134, 410, 411-413, 415, 419 nutrition labeling and, 37, 42-44, 56, J 57, 146 overreporting/overestimation, 56, 121- Japan, 135, 136 122, 130 Japanese Heart Foundation, 135 population-level or group, 17, 20, 121, Jason’s Deli, 182 122-127, 410 Joint National Committee on Prevention, portion sizes and, 45, 47-48 Detection, Evaluation, and Treatment processed foods, 36 of High Blood Pressure, 20, 31, 339 public health initiatives and, 5-8, 56, 61- 63, 120, 146 race/ethnicity and, 129-131, 136-137, K 413, 426-429 recommended maximum daily, 1, 56, Kellogg Company, 34, 156, 171 119, 124 Kentucky, 463 relative contributions of sources, 47-50 Kidney disease, 1, 21, 278, 326, 332, 340 sensory effects of lowering, 80-81 Kraft Foods, Inc., 97, 156, 170

OCR for page 473
 INDEX L palatability, 80-81, 82, 166, 167, 168, 179, 180-181, 191-192, 194, 239, Label claims. See Nutrition labels/labeling 242, 272 Lactic acid bacteria, 93-94, 95 particle size and structure modifications, Leavening agents, 98, 99, 101, 102, 104, 84-85 112, 113 physical properties, 98-102 Left ventricular hypertrophy, 21, 329 promotion and introduction, 267-268, Legumes. See Beans and legumes; Fruits 275 and fruit products; Vegetables and restaurant/foodservice offerings, 182-183 vegetable products safety and shelf-life issues, 95-97, 164, Level playing field, 2, 8, 13, 224, 239, 241, 166 242, 255, 260, 287, 329 sea salt use, 85 Levels of sodium in food supply silent sodium reductions, 72, 81-82, availability of lower-sodium products, 168-169, 171, 268 53-55 targeting for, 17 content of food, 45-47, 144, 146, 153 taste modification/manipulation, 8, 79- and intake trends, 59 87, 238-239 label claims and advertising, 50-51 tax incentives for, 247-248 monitoring needs, 147, 280, 444, voluntary industry efforts, 1, 4, 7, 25, 467-468 26, 146, 167-173, 237-238 preservatives, 100-101 public health initiatives and, 45-55 relative contributions of different M sources, 47-50, 153 Magnesium sulfate, 73, 405 Life Sciences Research Office, 217 Market basket studies, 148, 277. See also Listeria monocytogenes, 95, 96, 97, 112, Total Diet Study 275 Maryland, 345, 451, 461, 463 Listeriosis, 95 Mathematica Policy Research, 127 Lithium chloride, 75, 76, 405 Mayo Clinic, 134 Lower-sodium products McCain, 183 ad libitum salt use with, 82-84 McDonald’s, 175, 183, 237 availability, 8, 53-55, 146, 169, 170-171 Meats challenges to introducing, 95-102, brine injections, 96, 100, 101, 105 164-165, 166-167, 179-181, 242, contribution to sodium intake, 140, 141, 274-275 142, 265, 360, 434, 438, 439, 440, consumer education, 168, 170-171 441, 442 content claims, 8, 10, 29, 42, 50, 51, 52, fresh, 105, 214, 220, 224-225, 260-261, 53, 54, 55, 62, 63, 161, 167, 168, 271, 289 169, 192, 223-224, 228, 229, 230, functions of sodium in, 94, 95, 96, 97, 231-232, 240, 270, 271, 272-273, 98, 100, 101, 102, 105, 106-107, 289, 360 112 demand for, 8, 55-56, 167, 179, 183, iodine levels, 277 239 labeling, 224-225, 228, 271, 344 economic issues, 159, 166, 167, 179, kosher, 107 195 new product introductions, 159, 170 flavor substitutes, 84, 180 preservatives, 214 menu and menu item development, 71, processed, 80, 94, 95, 96, 97, 98, 100, 179-181 101, 102, 106-107, 112, 159, 170, motivation to develop, 8, 29, 50, 61, 63, 171, 275, 331, 344, 383, 402, 434 161 reduced sodium products, 170, 171, organic products, 166 251, 275, 344, 363

OCR for page 473
 INDEX regulation of, 220, 224-225, 289 combining higher and lower sodium sodium content of, 100 foods, 70-71 targets for salt reduction, 370-374, 383, estimating sodium in, 414 384, 385, 386, 390, 402 functions of sodium in, 111-112 value of shipments, 155 intakes of sodium from, 49, 140-141, Medications, 122-123, 278 142, 143, 434, 438 Menu planning tools for consumers 31, 33- labeling, 242 34, 266, 365 lower-sodium products, 170, 183 Menus and menu items new product introductions, 159 aggregation of high-sodium ingredients, sodium content, 112 71, 180-181, 308 sources of sodium in, 144 availability of ingredients, 180, 260 Mock salts, 84 calories, 173, 179, 224, 232, 270-271, Moisture-retaining agents, 99, 100, 102 459-466 Monitoring and evaluation categorizing, 448-449 consumer awareness and behavior, 280 challenges to introducing reduced GRAS modification, 257-259 sodium items, 179-181 implementation of strategies, 255 for children, 182 potassium, 258 cooking and flavoring strategies, 70, salt preference changes in, 81 181, 313 sodium content of foods, 147, 148, demand for health items, 181 259, 280-281, 294, 296, 316, 444, development of, 71, 177-179, 189, 260, 467-468 291 strategies for reducing sodium, 203-204, education of food preparers, 180, 181, 256-257, 259, 279-281 260, 291, 304-305 Monitoring sodium intakes food safety regulation, 230-231 24-hour recalls, 56, 58-59, 62, 121, 122, GRAS status applied to, 10, 230-231, 124, 134, 147, 148, 325, 410, 411, 259-260, 261, 286-287, 304-305 412, 414, 448 icons for healthy choices, 182 disappearance data, 55-56, 57, 62, 121, implementation of changes in, 2-3, 253, 145-146, 327 304-305, 307-309 expanding and enhancing, 294-296 incentives for change, 247, 304-305 recommendations, 294-296 military, 189 restaurant/foodservice items, 148 monitoring sodium in, 148, 294, 296, UPC sales data linked to Nutrition Facts 316 Panel, 280, 444, 467-468 nutrition labeling and education, 10, urinary sodium excretion, 11, 14, 59- 182, 223-232, 240-241, 270-271, 60, 62, 68, 80, 83, 121, 134-137, 273, 289-290, 304, 459-466 139-140, 147-148, 203, 245, 276, pre-processed ingredients, 260, 271 279-280, 294-295, 315, 329, 339, sodium content, 237 360, 363, 450 state and local regulations, 232, 240- Monocalcium phosphate, 102 241, 345-346, 459-466 Monosodium glutamate, 84, 99, 329, 330, Mexican American, 130, 131, 413, 426-427 406 Mexico, 155 Muscle foods. See Meats; Seafood products Microbial growth prevention, 92-93, 94, Myocardial infarction, 22 95-96, 97, 105, 106, 109, 110, 229, MyPyramid program, 31, 34, 266, 280, 293 251, 275, 314, 382, 391 Military feeding programs, 175, 176, 177, N 184, 185, 188-189, 252, 290 Mixed dishes N-Nitrosamines, 107 at-home preparation, 49, 153

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 INDEX National Health and Nutrition Examination development of, 169, 241 Survey (NHANES), 17 monitoring and evaluation, 450 data analysis methods, 409-415 packaged food, 444-448 hypertension prevalence from, 7, 61, participating organizations, 241, 346, 413 443, 450-451 iodine levels, 276 restaurant food, 448-449 Medical Examination Center, 61 targets, 241, 443, 445-448, 449, 450 overview, 409-410 National School Lunch and Child Nutrition sodium density data, 47 Act Amendments, 186 sodium intakes estimates from, 45, 47, National School Lunch Program and School 49, 56-59, 119, 120, 121, 122-133, Breakfast Program, 47, 184-187 135, 136, 137-140, 147, 410-413, New York City 448 National Salt Reduction Initiative, National Heart, Lung, and Blood Institute 169, 241, 246, 280, 299, 305, 346, (NHLBI), 18 443-451 FDA initiative with, 341 nutrition standards, 189-190 INTERMAP, 136 New York State, 451 INTERSALT, 135 Nestlé, 156, 169, 170 Joint National Committee on Prevention, Neutralizing agents, 99 Detection, Evaluation, and Treatment Nielsen Company, 444, 445, 447 of High Blood Pressure, 20, 31, 339 Nongovernmental organizations, mission, 266 government partnerships, 32-33 National High Blood Pressure Education North Karelia project, 359 Program, 30-31, 266-267, 293, 338, NPD Group, 176, 448 339 Nutrient standards for private-label past recommendations and initiatives, products, 159 32-33, 338-340 Nutrition Facts Panel Prevent and Control America’s High changes to, 226-228, 288-289 Blood Pressure: Mission Possible, Daily Value for sodium, 10, 218, 225- 340 228, 269-270, 288-289, 327, 342, National High Blood Pressure Education 366-367, 457 Program, 30-31, 266-267, 293, 338, establishment, 224 339 example, 457 National Institutes of Health (NIH), 31 frequency of consumer use of, 42-44, 62 National Nutrient Database, 57, 114, 133 UPC sales data linked to, 280, 444, National Nutrition Monitoring and Related 467-468 Research Program, 122 Nutrition Labeling and Education Act National Nutrition Monitoring System, 37, (NLEA), 33, 36, 42, 50, 52, 222, 62 223-230, 231-232, 271, 272, 273, National Research Council 289-290, 330 reference values for nutrients, 226-227 Nutrition labels/labeling. See also Nutrition summary of past reports and Facts Panel recommendations of, 30, 32-33, background, 223-225 347-348 by category of foods, 50-51 National Restaurant Association, 173, 174, content claims, 8, 10, 29, 42, 50, 51, 176, 181 52, 53, 54, 55, 56, 62, 63, 146, 161, National Salt Reduction Initiative 167, 168, 169, 192, 223-224, 228, approach, 299, 346, 444-449 229, 230, 231-232, 240, 270, 271, categories of foods, 241, 245, 298, 299, 272-273, 278-288, 289, 360 443-445, 446, 448-449 definitions of claims, 229, 231 databases, 444, 448, 450 exemptions, 231-232

OCR for page 473
 INDEX FDA requirements, 10, 33, 36-37, 42, and sales volume, 50, 51, 316, 342, 365, 50, 173, 222-224, 225-226, 227, 444, 445-446, 467-468 228-229, 230-232, 239, 268-269, shelf label claims, 173 273, 288-289, 301, 303, 338, 341, single-ingredient raw products, 224-225, 342 271 frequency of industry use, 8, 54-55, 272 standards for, 223-230, 288-289, 342 front-of-package, 172, 173, 245, 246, state and local initiatives, 232, 240-241 268-269, 301, 363, 366-367 step-down approach, 272-273, 301-303 future of claims, 272 trends in use, 42-44, 50-51, 199 GRAS modification and, 222, 301-303 voluntary, 36-37, 42, 50, 168, 220, 223- guidelines for, 224-225, 350 225, 243-244, 245, 271, 360, 362, health claims, 8, 10, 29, 42, 45, 50-51, 363, 366-367 52-53, 161, 173, 220, 223-224, 230, warning/disclosure statements, 201-202, 231-232, 240, 271-273, 324, 342 217, 222, 288-289 “healthy” claim, 221, 228-229, 272, Nutrition Program for the Elderly, 185 342 Nutrition rating and scoring systems, 168, “High Salt Content,” 360 172, 173, 182 implementation of recommended Nutrition Services Incentive Program, 185 strategies, 301-303 Nuts and seeds, 51, 113, 114, 143, 247, incentive value to producers, 29, 45, 50, 328, 437 161, 224, 226, 240, 270, 271-272, 289, 343 O and intakes of sodium, 37, 42-44, 56, 57, 146 Obesity and overweight, 6, 20, 21, 30, 47, international, 159, 243-244, 245, 246, 61, 123, 182, 183, 224, 232, 248, 360, 362, 363 266, 350 “Low Salt,” 360 Occupational Safety and Health mandatory, 33, 36, 42, 50, 52, 56, 146, Administration, 456 159, 213, 222, 223-230, 231-232, Office of Disease Prevention and Health 243, 271, 272, 273, 289-290, 291, Promotion, 18 330, 342 Office of Management and Budget, 454, NLEA requirements, 33, 36, 42, 50, 52, 455 222, 223-230, 231-232, 271, 272, Oklahoma, 464 273, 289-290, 330 Oregon, 345, 451, 461 nutrients other than sodium, 8, 43, 50, Osteoporosis, 30, 53 223, 229, 268-269, 457 percentage/number of products with, 42, 55 P point-of-purchase information, 4, 24, 25, 26, 29, 36-37, 42, 61, 168, 172, Palatability of foods, 2, 15, 67, 68-69, 70, 187, 193, 223, 225, 232, 236, 240- 71, 74, 79, 81, 82, 84, 91, 100, 241, 268-273, 293, 459, 461 192, 195, 239, 242, 256, 273, 311, private label products, 159 312, 313. See also Flavor; Salt taste reading and interpreting, 42-44, 191, preference; Taste 199, 201-202, 223, 225, 265, Pastas and noodles, 104, 105, 112, 140, 268-271 141, 142, 159, 182, 383, 384, 385, recommendations, 10-11, 288-290 394, 434, 435, 438, 439, 440, 441, regulation, 223-230, 231-232, 291, 342 442 restaurant/foodservice menus, 10, 182, Patient Protection and Affordable Care Act, 223-232, 240-241, 270-271, 273, 224, 232, 270, 271, 459 289-290, 304, 459-466 Pennsylvania, 451, 464

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 INDEX PepsiCo Inc., 156, 171 challenges and innovations for lowering Philadelphia, nutrition initiatives, 345, 451, sodium, 95-97 460 combining methods for, 92, 93 Physical properties of food fermentation role, 92, 93-94, 97, 104, alternatives of sodium containing 110, 111, 328 compounds, 102 historical context for salt use, 68, 91, challenges and innovations for lowering 214 sodium, 98-102 levels of sodium and, 100-101 role of sodium, 97-98 microbial growth prevention, 91, 92-93, sodium-containing compounds other 94, 95-96, 97, 105, 106, 109, 110, than salt, 99 112, 229, 251, 275, 314, 382, 391 Point-of-purchase information, 4, 24, 25, refrigeration, 91-92, 95, 96, 109 26, 29, 36-37, 42, 61, 168, 172, 187, shelf-life extension, 91, 92, 95, 100, 193, 223, 225, 232, 236, 240-241, 105, 108 268-273, 293, 459, 461. See also sodium-containing compounds other Nutrition labeling than salt, 91, 92, 94 Portion/serving size, 14, 45, 47-48, 49-50, Processed foods. See also Food industry; 100, 179, 184, 190, 197-198, 260, Reduced-sodium products 266, 291-292, 304, 308, 392 cap and trade system, 249-250 Potassium challenges to introducing reduced- adverse effects, 251, 259, 278, 279, 281, sodium products, 166-167 329, 405 economic value of shipments, 154, 155 dietary guidelines, 86, 251, 278, 341 efforts to reduce sodium, 167-173 drug interactions, 278, 332 expenditures by type of outlet, 158 health claims, 230 imports, 155 and hypertension, 61 industry characteristics, 154-159 monitoring needs, 258 intakes of sodium, generally, 36, 154 physiological role, 330 labeling, see Nutrition labels/labeling and salt sensitivity, 24 manufacturing, 154-157, 159-166 as salt substitute, 71, 73, 85, 86, 97-98, new product introductions, 159, 169, 251, 278-279, 307, 313, 330, 341, 170-171 405, 406 nutrition standards, 159, 169 taste, 76, 313, 330 packaging, 48, 92, 97, 112, 159, 164- Potassium bicarbonate, 102 165, 168, 171-172, 251-252, 381 Potassium chloride, 71, 73, 85, 86, 97-98, private label products, 155-156, 159, 251, 278-279, 307, 313, 338, 341, 166, 288, 444, 446, 447, 468 405, 406, 407 product development process, 159-166 Potassium citrates, 102 reformulated products, see Lower- Potassium-enriched Pansalt, 248, 360 sodium products Potassium glutamate, 73, 406 retailing, 157-159, 163, 166, 172 Potassium hydrogen tartrate, 104 slotting fees, 158, 159, 166 Potassium lactate plus sodium diacetate, top processors, 155, 156 97, 406 top retailers, 158 Potassium phosphates, 101, 102 Product development Potassium sodium L-tartrate, 99 business groups involved in, 159-161 Predictive Microbiology, 314 concept development, 164 Preservation of foods, 3. See also Food economic issues, 159, 163-164, 165, safety; Functions of sodium additives 166, 167 in foods food safety considerations, 164-165 by category of food, 105, 106, 110, 112, idea generation, 161-164 114 launch and produce, 165

OCR for page 473
 INDEX menus and menu items, 71, 177-179, Recommendations. See also Strategies for 260 sodium reduction plan and design, 164-165 charge to committee, 19-20 private label foods, 166 committee approach, 3-5, 19-27, 235 process steps, 159-166, 179 context for, 5-8 reformulated products, 161, 164-165, development of, 24-27 167 implementation, 14-15 smaller companies, 160, 161, 166 information gaps, 14-15 Professional organizations. See also interim strategies, 10, 13-14, 285-286, 287-288 indiidual organizations health professional training, 267 monitoring sodium intakes, 194-196 scope of past initiatives, 30 past, by year and sponsor, 30, 32-33 Protein, 186, 189, 223, 224, 232, 271, 459, primary strategies, 8-9, 10, 12-13, 285, 463, 465 286-287 Public health initiatives. See also indiidual scientific rationale for decisions, 19-24 statement of task, 18-19 departments, agencies, and programs and consumer awareness and behaviors, supporting strategies, 10-12, 13-14, 286, 37-45 288-296 consumer-oriented, 26, 37-45, 235-241 target population, 3, 20, 22-24 effectiveness, 1, 45-55, 61-63, 236, 238 Recommended Dietary Allowances, 186, and hypertension prevalence, 60-61 226, 227, 327, 331, 347 industry response to, 4, 25, 36-37, Reduced-sodium products. See Lower- 237-238 sodium products and intakes of sodium, 1, 5-8, 17, 56, Reduction of sodium in foods. See also 61-63, 120, 146 Incentives to lower sodium; Lower- international initiatives, 239-241, 246 sodium products; Public health lessons learned, 235-241, 242 initiatives; Strategies for sodium and levels of sodium in food supply, 45- reduction 55, 236 adverse effects, 274 linking sodium reduction programs to, economic theory applied to, 193-198 49-50 challenges for processed food industry, message to consumers, 35 74, 95-97, 98-102, 166-167 outcomes, 37-61, 236 competing nutrition priorities, 183-184 point-of-purchase information, 26, 36- cost-effectiveness, 21-22, 166 37, 236 food safety issues, 95-97, 251-252, scope of past and current initiatives, 20, 274-275 26, 30, 32-33, 34, 336-346 funding, 310-311 Public-private partnerships, 11, 15, 19, 32- GRAS status of salt and, 169, 218-222, 33, 263, 288, 291, 293, 307, 309 253-262 health theory applied to, 198-199 implementation activities, 307-309 Q industry efforts, 1, 4, 7, 10, 13, 25, 26, 29, 36, 167-173, 242, 287-288 QSR50, 448 international initiatives, 169 Quinine hydrochloride, 73 and iodine insufficiency, 275-278 monitoring and evaluation, 259, 280-281 R and physical properties of foods, 98- 102, 251-252, 255 Race/ethnicity, intakes by, 129-131, 136- and potassium intake from salt 137, 413, 426-429 substitute, 278-279

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 INDEX and preservation of foods, 95-97 Restaurant/foodservice operations. See public health programs linked to, 49-50 also Fast food; Food industry; public-private partnerships, 11, 15, 19, Foodservice; Menus and menu items; 263, 288, 291, 293, 307, 309 Restaurants; School food silent reductions, 72, 81-82, 168-169, chains, 176, 178-179, 180-181, 259, 255 261 statutory mandates, 33 commercial establishments, 174-176 stepwise approach, 2-3, 72, 81-82, 186, contributions of sodium to doos supply, 192, 194, 242, 252-254, 255-257, 259 272-273, 286, 301-303 distribution sector, 180 time line for, 310 efforts to reduce sodium, 8, 181-184 unintended consequences, 273-279, implementation of recommendations, 280-281 304-305 Reference amount customarily consumed, independent, 176, 177-178, 259-260, 103, 105, 107, 108, 110, 111, 112, 261, 270, 291 113, 114, 115, 445 industry characteristics, 173-177 Refrigeration, 91-92, 95, 96, 109 information sources for, 173, 175 Regulation. See also GRAS status; Nutrition institutional (noncommercial), 175, 176, labels/labeling; indiidual statutes 189-190 of advertising, 224, 268, 341 military, 175, 177, 189 approval process for food additives, perceptions of sodium intakes, 41-42 215-216 portion sizes, 198 costs and benefits, 453 production and delivery within food FDA jurisdiction, 8, 9, 12-13, 15, 36, environment, 173-184 164, 169, 214, 215-221, 223, 254, sales volume, 173, 176-177 255, 256, 259, 260-261, 262, 275, standardized operations, 10, 176, 178, 277, 286-287, 298, 303, 305-307, 179, 180-181, 259-260, 261, 263, 310, 342, 343, 348, 350 286, 287, 289-290, 304, 308 GRAS substances, 216-217 state and local foodservice operations, new products, 164 189-190 nutrition labeling, 223-230, 231-232 top companies, 175 resource and cost issues, 262 types, 174, 176-177 restaurant/foodservice operations, Restaurants. See also Fast food; Food 230-232 industry; Foodservice; Menus and rulemakings, 213, 219, 257-258, 342, menu items 343, 344, 453-456 defined, 46, 176 salt, 216-222, 227 sodium intake density of foods, 46, 145, school meals, 186 198 sodium-containing compounds other Rice and rice products, 72, 103, 104, 105, than salt, 222-223, 262, 287 112, 142, 159, 246-247, 384, 385, state and local initiatives, 232 395, 396, 434, 435, 439, 442 USDA jurisdiction, 220, 224-225, 228, 260-261, 268, 273, 289, 343, 344, S 445 Renal. See Kidney disease Salad dressings, 94, 96, 110, 142, 143, 144, Research needs 170, 197, 391, 436 monitoring and surveillance, 315-316 Salt (sodium chloride) salt taste, 74, 311-313 distinguished from sodium, 24 sodium additives, 100, 101 sensitivity, 3, 18, 24, 331 sodium reduction in food, 313-314 sensory properties, 2 supporting consumers, 314-315

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0 INDEX Salt Institute, 56, 57 recommendations, 252 Salt need, 77 regulation of nutrient content, 186, 190 Salt preference. See also Taste sodium intake densities, 46, 47, 145 age-related differences, 78-79 School Nutrition and Dietary Assessment defined, 26, 77 Study (Third), 47, 127 early development of, 2, 23, 24, 35, Sea salt, 85, 251, 307, 332, 405, 412 77-79 Seafood products, 94, 98, 107, 144, 155, evolution of, 76-78, 236, 239 177, 224, 242, 260, 271, 277, 289, modification/manipulation in adults, 2, 333, 360-361, 384, 385, 386, 390, 79-87, 193, 239-240, 242, 258-259 398, 400, 402, 415, 434, 442 monitoring changes in, 81 Seattle and King County, nutrition research needs, 78 initiatives, 345, 451, 459-60 source of foods and, 7, 47 Select Committee on GRAS Substances Salt/sodium substitutes (SCOGS), 36, 217, 341 applications, 8, 405-407 Serving size. See Portion serving/size examples, 405-407 ServSafe program, 305 mixture with sodium chloride, 86, 407 Shelf life of products, 91, 92, 95, 100, 105, potassium chloride, 71, 73, 85, 86, 108, 164, 166, 258, 275, 313-314, 97-98, 251, 278-279, 307, 313, 338, 370 341, 405, 406, 407 Snacks. See Savory snacks sea salt, 85, 251, 307, 332, 405, 412 Social cognitive theory, 198 sodium channel receptors and, 75 Societies of Epidemiology, 451 Salt taste Sodexo, 176, 183 bliss point, 71-72 Sodium acetate, 73, 74, 94, 99 enhancers, 5, 76, 85, 87, 195 Sodium acid pyrophosphate, 99, 102, 104 evolution of, 76-77 Sodium alginate, 99, 101, 109, 251 intensity, 71, 72, 87 Sodium aluminum phosphate, 99, 102 Just Noticeable Difference, 81-82 Sodium ascorbate, 94, 106, 107, 119 mechanisms of, 75-76, 85 Sodium benzoate, 94, 119, 332 persistence, 71, 80-81 Sodium bicarbonate, 98, 99, 102, 104, 119, Sara Lee Corp., 156, 171 122, 332, 376 Saturated fat, 21-22, 30, 43, 44, 50, 52, Sodium channel receptors, 75-76 159, 184, 186, 224, 226, 228, 232, Sodium citrates, 99, 102, 109 269, 270-271, 327, 331-332, 366, Sodium-containing compounds other than 387, 457, 459-460, 461, 462, 463, salt 464, 465 bitterness of, 75 Sauces and stocks, 96, 98, 110, 112, 140, neutralizing agents, 73, 74, 94, 99 171, 182, 242, 360, 383, 385, 390- preservatives, 92, 94 392, 394, 398, 434, 446 Sodium content of food. See also Levels of Savory snacks, 48, 97, 113, 141, 142, 159, sodium in food supply 173, 190, 248, 387-388, 393 additives by category of food, 103-115 Scanner data, 157, 467, 468. See also benchmark, 47 Universal Product Code implementing changes in processed foods School foods and menu items, 2-3, 307-309 defined, 46 label claims, 10, 29, 42, 50, 51, 52, 53, 54, foodservice operations, 176 55, 62, 63, 161, 167, 168, 169, 192, HealthierUS School Challenge, 34, 186- 223-224, 228, 229, 230, 231-232, 240, 187, 344 270, 271, 272-273, 289, 360 lower-sodium offerings in, 182 school lunches and breakfasts, 47 National School Lunch and School source of foods and, 45-47 Breakfast Programs, 47, 184-187, trends, 236-238 344

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 INDEX Sodium deficiency, 77 international experience, 30, 169, 239, Sodium depletion, 78 241-246, 357-368 Sodium diacetate, 94, 96-97 lessons learned from past initiatives, Sodium erythorbate, 94, 106, 107 235-241 Sodium hydrogen carbonate, 99, 102 low-sodium foods with ad libitum salt Sodium metabisulfite, 99, 102, 105 use, 82-84, 257 Sodium nitrite, 94, 95, 106-107 model for population-wide reductions, Sodium phosphates, 94, 98, 99, 102, 109 79-81 Sodium stearoyl lactylate, 99, 104-105 monitoring, 203-204, 256-257, 259, Sodium tripolyphosphate, 98, 99, 101 279-281 Souplantation/Sweet Tomatoes, 183 particle size and structure modifications, Soups, 49, 72, 73, 111, 112, 153, 154, 159, 84-85 170, 183, 242, 331, 360, 386, 434, policy/regulatory changes, 202-204, 438 253-262 Sous vide products, 96 preservatives, 95-97 Special Supplemental Nutrition Program processing methods, 100, 101, 102-103, for Women, Infants, and Children 111, 251-252 (WIC), 34, 131, 184, 185, 188, 252, scope of past recommendations and 290, 345, 413, 430 initiatives, 30-37 Stabilizing agents, 99, 101, 110 sea salt, 85, 251 Staphylococcus aureus, 96 sensory approaches, 81-84, 250-251 State and local governments. See also substitutes and enhancers, 85-87, 168, 251 taste/flavor modification/manipulation, indiidual states funding for cardiovascular disease 70-71, 72, 79-87, 101, 203-204, prevention, 267, 293 258-259 nutrition standards, 189-190, 232, 240- technological approaches, 74, 100, 102- 241, 345-346, 459-466 103, 169-170, 250-252, 259 “sin” takes, 248-249 Stroke, 1, 20, 21, 22, 60, 62, 230, 241, summary of past activities and 243, 326, 327, 332, 362-363 recommendations of, 30, 32-33 Subway, 183 State Heart Disease and Stroke Prevention Sugar substitutes, 51, 85, 87, 170, 222, Program, 267, 293 274-275, 331 Stocks. See Sauces Sugars, 7, 43, 44, 51, 52, 55, 73-74, 92, 94, Strategies for sodium reduction. See 95, 103-104, 105, 155, 159, 186, Consumer education; Implementation 249, 275, 277, 329, 361, 366, 436, of strategies; Public health initiatives; 457, 461, 463, 465 Recommendations; Reduction of Summer Food Service Program, 185 sodium in foods; Supporting strategies Supplemental Nutrition Assistance Program combining higher and lower sodium (SNAP), 131, 184, 185, 187, 188, foods, 70-71 252, 290, 413, 430 comprehensive approach, 49-50, 63, 79- Supplements, dietary, 122, 123, 124, 134, 81, 202-204, 242 187, 276, 410, 411-413, 415, 419 consumer oriented, 62, 168, 170-171, Supporting strategies. See also Nutrition 190-192, 263-273 labels/labeling; Reduced-sodium cooking techniques, 70 products cost-effectiveness, 1, 247, 248, 357 point-of-purchase information, 4, 24, folic acid example, 63, 203, 204, 25, 26, 29, 36-37, 42, 61, 168, 172, 254-255 187, 193, 223, 225, 232, 236, 240- food supply approach, 2, 63, 239-240, 241, 268-273, 293, 459, 461 242, 254-255, 263 reduction of sodium in processed foods, in government food programs, 252-253 1, 4, 25, 26, 29

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 INDEX Surgeon General, recommendations and impact of salt reduction program, 244, initiatives, 32-33, 337 245, 367-368, 446 Sysco, 180 intakes of sodium, 242, 245, 367-368 INTERMAP study, 135 microbial safety of food products, 95- T 96, 274-275 nutrient standards for private-label Take-out foods, 173, 326, 328 products, 159 Taste. See also Flavor; Salt preference; Salt recommended sodium intakes, 363 taste Salt Reduction Campaign, 169, 241-242, bitter, 69, 71, 73-74, 75, 85, 86, 109, 244-245, 298, 299, 363-403, 443 251, 307, 313, 330, 332, 405, 406 target salt reductions by food category, qualities of, 69, 71 244-245, 370-403, 446 sour, 69, 104, 332, 406 Universal Product Code (UPC), linking sweet, 69, 70, 71, 72-73, 74, 85, 332 to Nutrition Facts label, 280, 444, as synonym for flavor, 69 467-468 technical definition, 69 Urine analysis, measurement of sodium umami, 69, 84, 330, 333, 406 intakes, 11, 14, 59-60, 62, 68, 80, Tennessee, 451, 465 83, 121, 134-137, 139-140, 147-148, Texas, 465 203, 245, 276, 279-280, 294-295, Texture-modifying agents, 91, 97-98, 99, 315, 329, 339, 360, 363, 450 101, 103, 104, 108, 109, 111, 112, U.S. Department of Agriculture. See also 113, 378 Dietary Guidelines for Americans; Theory of reasoned action, 198 National Health and Nutrition Thickening agents, 98, 99, 109, 373, 406 Examination Survey Tolerable Upper Intake Level, 18, 121, 125, categories for packaged foods, 445 126, 127, 128, 227, 289, 327, 332, Child and Adult Care Food Program, 344, 347, 358, 413, 420, 421, 422, 185 423, 426-433 Commodity Distribution Program, 34, Total Diet Study, 12, 38, 103, 112, 114, 185-186, 252, 344, 345 145, 146-147, 277, 280, 295, 359 Commodity Supplemental Food Total fat, 43, 44, 186, 226, 327, 366, 457, Program, 185 461, 463 Diet and Health Knowledge Surveys, 39- Trans fat, 21, 44, 183-184, 265, 305, 457, 40, 41, 43, 44, 201 460, 461, 462, 463 Economic Research Service, 57 Transglutaminase, 101 Emergency Food Assistance Program, Trials of Hypertension Prevention, 203 185 Trials of Nonpharmacologic Interventions in Food and Nutrition Service, 184 the Elderly, 203 Food Assistance for Disaster Relief, 185 food composition database, 145, 295- 296, 409, 412 U Food Distribution Program on Indian Reservations, 185 Ultrafiltration, 100 Food Guide Pyramid, 338 Unilever, 156, 171, 238 foodservice information, 173, 175 United Kingdom Fresh Fruit and Vegetable Program, 185 awareness campaign, 244, 366 funding for strategies, 311 food category framework, 245, 298, HealthierUS School Challenge, 34, 186, 299, 370-403, 444-445, 446 344 food industry involvement, 244-245, Household Food Consumption Surveys, 364-365 409 labeling initiatives, 245, 246, 366-367

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 INDEX V MyPyramid program, 31, 34, 266, 280, 293 Vegetables and vegetable products, 21, 30, National Nutrient Database, 57, 114, 63, 71, 84, 94, 110, 111, 112, 114, 133 140, 141, 142, 147, 155, 159, 179, National School Lunch Program, 181, 184, 185, 192, 196, 197, 224, 184-187 247, 266, 308, 315, 327, 328, 333, Nutrition Program for the Elderly, 185 341, 345, 361, 384, 385, 386, 390, Nutrition Services Incentive Program, 399, 400, 403, 406, 434, 435, 440, 185 441, 446. See also Beans and legumes Predictive Microbiology website, 314 Vending machine foods, 145, 184, 190, regulatory authority, 185, 217-218, 220, 326, 350, 413 224-225, 228, 260-261, 268, 273, Vermont, 465-466 289, 343, 344, 445 School Breakfast Program, 184-187 SNAP, 131, 184, 185, 187, 188, 252, W 290, 413, 430 summary of past activities and Wal-Mart, 100, 157, 158, 149, 468 recommendations of, 30, 32-33 Washington State, 451 Summer Food Service Program, 185 Water supporting strategies recommended activity of foods, 74, 92, 93, 95, 104, for, 10, 11, 12, 13, 288-289, 294, 105, 106, 109, 113, 333 295-296 sodium sources, 114, 115, 123, 124, WIC program, 34, 131, 184, 185, 188, 133-134, 411 252, 290, 345, 413, 430 West Virginia, 451, 454 U.S. Department of Commerce, 154 White House Conference on Food, U.S. Department of Defense, 185, 188-189 Nutrition, and Health, 5, 30, 32-33, U.S. Department of Education, 18 235, 336 U.S. Department of Health and Human Whites, non-Hispanic, 130, 131, 136-137, Services, 18. See also Dietary 413, 426-427 Guidelines for Americans; indiidual World Action on Salt and Health, 32-33, agencies 351 past recommendations and initiatives, World Cancer Research Fund (WCRF), 32-33 32-33, 351 recommendations to, 3 World Health Organization (WHO), 30, U.S. Department of Justice, 185 32-33, 135, 348, 357 U.S. Department of Labor, 18, 185, 346, World Hypertension Day, 33, 351 456 World Hypertension League, 32-33, 351, U.S. Department of Veterans Affairs, 185 451 U.S. Environmental Protection Agency, 454 World Salt Awareness Week, 33, 351 U.S. Foodservice, 180 Worlds of Healthy Flavors conference, 181 U.S. Public Health Service, 32-33 U.S. Senate Select Committee on Nutrition and Human Needs, 30, 32-33, 337 Y Yersinia enterocolitica, 96

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