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Strategies to Reduce Sodium Intake in the United States
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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calories, 48, 49, 145, 197-198
characterizing sodium in, 141-145
consumer awareness and behavior, 17, 44-45, 191
defined, 415
intakes of sodium from, 2, 35, 36, 44-45, 48-49, 82-84, 123, 124, 133, 141, 143-145, 411, 412, 414-415, 418-419, 442
mixed sources, 49
portion size and, 48, 197-198
preparation time considerations, 196-198
sodium intake density, 45-46, 47, 49-50, 143-144, 145, 414
At-risk subpopulations
defined, 17, 132
intakes, 119, 132-133, 135-136, 432-433
size of, 119
targeting, 62
Australia, 101
Away-from-home foods.
See also Restaurant/foodservice operations
calories, 48, 49, 145, 197-198
characterizing sodium in, 141-145
consumption trends, 173, 196-198
defined, 415
intakes of sodium from, 48-49, 141, 143-145
portion size and, 48, 197-198
sodium intake density, 45-46, 47, 49-50, 143-144, 145, 414
B
Bacillus species, 96, 105
Bakery/baked goods
intakes of sodium from, 141, 142, 144, 439, 440, 441
iodine content, 276, 277
labeling, 242
reduced-sodium products, 82, 159, 170, 171, 239, 243, 245, 363
salt substitutes, 405
sodium additives and their functions, 94, 97, 104-105
sodium content of, 82, 100, 105, 236, 360, 435, 442
target sodium reductions, 364, 375-376
value of shipments, 155
Beans and legumes, 110, 111, 142, 143, 247, 328, 344, 383, 400, 434, 435, 437
Beverages, 50-51, 94, 114-115, 141, 143, 159, 170, 174, 175, 177, 184, 195, 248, 402, 412, 437, 460, 462.
See also Water
Bleaching agent, 99
Body mass index, 21, 61, 326
Bone health, 30, 77
Botulism, 96, 107
Breads. See Bakery/baked goods
Breakfast cereals, 103-104, 141, 142, 159, 242, 344, 360, 364, 377, 435, 438, 439, 441, 442
British Heart Foundation, 135
Buffering agents, 99
Burger King, 175, 182
C
Caffeine, 73
Calcium
coronary artery scores, 23
deficiency and salt intake, 77
health claims, 228
leavening agents, 102, 104
nutrient content claims, 53, 457
salt substitutes, 97, 405, 406
taste receptor, 75-76
and water hardness, 133
WIC qualifying foods, 188
Calcium acid pyrophosphate, 102, 104
Calcium chloride, 97, 405
Calcium diglutamate, 406
Calcium lactate, 406
Calcium phosphates, 102
California, 345, 450, 460-461
Calories
advertising positive claims, 53, 54, 55
at-home vs. away-from-home consumption, 48, 49, 145, 197-198
consumer concerns about, 44, 179, 194
defined, 326
industry concerns about, 192
label information, 8, 43, 223, 229, 268-269, 457
menu information, 224, 232, 270-271, 459-466
restaurant/foodservice items, 173, 179, 224, 232, 270-271, 459-466
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school meals, 186
sodium intake relationship, 6, 21, 45-46, 47, 49-50, 59, 128-129, 130, 137-140, 141-142, 143, 145, 266, 307-308, 309, 314, 315
surveys of intakes, 411
Campbell Soup Company, 34, 168, 170, 171, 237
Canada
food industry characteristics, 155, 156, 157, 158
hyperkalemia, 279
intakes of sodium, 358
sodium reduction initiatives, 241, 243, 358-359
Canadian Community Health Survey, 358, 359
Canadian Heart Foundation, 135
Cancer, 30, 53, 340, 351
Carbohydrates, 108, 223, 224, 232, 271, 459, 460, 462, 463, 464, 465
CARDIA study, 136-137
Carrageenan, 109
Categories of foods.
See also specific categories
characterizing sodium contributions by, 140-147, 414-415
FDA standardization of, 299, 445, 446
functions of sodium additives by, 103-115
intakes of sodium by, 122, 140-141, 142-143, 414-415, 434-437
label claims by, 50-51
GRAS status modification framework, 298-301
menu items, 448-449
new product introductions by, 159
portion sizes differences by, 48
preservative uses of sodium by, 105, 106, 110, 112, 114
target salt reductions by, 242, 370-403, 446
UK framework, 241, 245, 298, 299, 370-403, 444-445, 446, 448-449
USDA standardization of for packaged foods, 445
Center for Science in the Public Interest, 34, 169
Centers for Disease Control and Prevention (CDC), 18, 119
Division of Heart Disease and Stroke Prevention, 267
public education, 267, 268, 295, 340
recommended strategies for, 11-12, 278, 294-295
sodium reduction activities, 336
State Heart Disease and Stroke Prevention Program, 267, 293
summary of past activities and recommendations of, 32-33, 336, 340
surveys, see National Health and Nutrition Examination Survey
Cereal. See Breakfast cereals;
Grains and grain products
Characterizing sodium in food supply
contributions by food category, 140-147, 414-415
disappearance data, 55-56, 145-146
identifying food sources, 140-145
market basket study, 146-147;
see also Total Diet Study
national food composition databases, 137, 145, 147, 148, 295-296, 409, 412
prepared at home vs. away from home, 141-145
Chartwells School Dining Services, 182
Child and Adult Care Food Program, 185
Children and youth.
See also Adolescents;
Infants
advertising targeted at, 268
AI, 120, 126
blood pressure levels, 21, 23, 60, 78
fast food consumption, 197
genesis of hypertension, 23
intakes and intake density of sodium, 5, 6, 58, 59, 123, 125, 126, 129, 130, 138, 358, 418-425, 430-431
international trends, 358
interventions targeting, 35, 186-187, 200, 268, 344
preference for salt, 24, 78-79, 81
public health concerns about, 127
recommendations for, 349
reporting intakes of, 121-122, 130
restaurant menu items, 182
school breakfast and lunch programs, 47, 184-187, 344
sodium-to-calorie intake, 130
sources of sodium, 103, 418-421
UL, 127, 358
WIC program, 34, 131, 184, 185, 188, 252, 290, 345, 413, 430
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China, 68, 136, 155
Cholesterol, 7, 41, 43, 44, 52, 55, 226, 228, 265, 269, 327, 409, 457, 463, 465
Clostridium botulinum, 96, 107, 112, 275
Clostridium perfringens, 96
Commodity Distribution Program, 34, 185-186, 252, 344, 345
Commodity Improvement Council, 186
Commodity Supplemental Food Program, 185
Compass Group, 176, 182
ConAgra, 156, 182
Condiments, 94, 110, 141, 142, 143, 159, 436
Confections, sweets, and desserts, 113-114, 141, 142, 155, 159, 177, 388, 389, 396-397, 436
Congressional Omnibus Appropriations Act, 33, 336
Consolidated Appropriations Act of 2008, 18
Consumer awareness and behaviors
at-home use of salt, 17, 44-45, 191
economic theory applied to, 193-198
food choice behavior, 192-193
food environment and, 62-63, 153, 190-204, 236
food preparation time and, 194, 196-198
monitoring, 280
national focus, 263-268
nutrients other than sodium, 41, 43, 44, 179, 194
nutrition label understanding and use, 42-44, 50-51, 191, 199, 223, 225, 265, 268
perceptions of intake, 38-40, 146, 201, 236, 269
personal importance of avoiding sodium, 40-41
and portion size, 48
social ecological model, 264, 293
sodium/health relationship, 38-40, 191, 195, 198-199
strategies to support changes in, 190-192, 263-273, 291-294
sustainability of interest, 63
value associated with food and, 194-196
warning labels and, 201-202
Consumer education
behavior change models, 264, 293-294
competing messages about other nutrients, 7, 191, 266
coordinated messaging, 199-201, 263-264, 265-266, 292-293
core message, 37
design of, 200-201
health communication campaigns, 35, 62, 195, 199-201, 264-265
industry efforts, 30, 34, 168, 170-172, 181-183
international initiatives, 242
menu planning tools, 31, 34, 365
national focus, 263-268, 292-293
nutrition labeling strategies, 42-44, 191, 201-202, 268-271
online health/nutrition information sites, 34, 171-172, 181-183
outcomes of, 6-7, 37-45, 62-63, 146, 191
outreach opportunities and tools, 266-268, 309
point-of-purchase information, 4, 24, 25, 26, 29, 36-37, 42, 61, 168, 172, 187, 193, 223, 225, 232, 236, 240-241, 268-273, 293, 459, 461
public health messages and campaigns, 30, 191
strategies, 264-265
target population, 35, 191
Consumer theory, 194-196
Consumption of salt/sodium. See Intakes of sodium/salt
Content. See Sodium content of food
Continuing Survey of Food Intakes by Individuals, 48, 49, 197-198
Culinary Institute of America, 181
D
Daily Reference Value, 227, 344
Daily Value for sodium, 10, 218, 225-228, 269-270, 288-289, 327, 342, 366-367, 457
Dairy foods
butter, 108, 109, 242, 360, 381, 382, 397, 436
cheese, 80, 93-94, 96, 97-98, 100, 102, 108-109, 112, 113, 140, 141, 142, 143, 144, 180, 182, 186, 242, 275, 308, 360, 364, 375, 378-381, 384, 386, 387, 390, 405, 434, 436, 438, 439, 440, 441, 442, 449
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economic value of processed foods, 155
functions of sodium in, 97-98, 100, 102, 108-109, 112, 113
milk, 51, 101, 109, 113, 114, 141, 436, 438
new product introductions, 159
other products, 108, 109, 143
sodium content of, 100
Delaware, 451, 462
Denny’s, 182
Density of sodium intake
age and, 6, 58, 59, 129, 138, 139, 424-425
at-home vs. away-from-home, 45-46, 47, 49-50, 143-144, 145, 414
calculation, 148
defined, 6, 45, 129
gender and, 6, 58, 59, 129, 130, 138, 139, 424-425
meeting dietary guidelines, 59, 63, 139, 266
portion size and, 47, 48, 198
sodium-to-calorie correlation values, 130
survey comparisons using, 58
trends over time, 6, 57, 58, 59, 128-129, 137-140, 144, 238
Diabetes, 30, 278, 340
Dicalcium phosphate, 102
Diet and Health Knowledge Surveys, 39-40, 41, 43, 44, 201
Dietary Approaches to Stop Hypertension (DASH) feeding trials, 136, 237, 327
Dietary Guidelines Advisory Committee, 20, 23, 24
Dietary Guidelines for Americans
at-risk populations defined, 17, 132
defined, 327
linking health messages to, 263, 266, 292, 338, 350
military adherence to, 189
revision, 310, 327
sodium intake densities and, 59, 63, 139, 266
sodium recommendations, 1, 3, 6, 17, 18, 31-32, 36, 47, 56, 59-60, 62, 119, 123, 124, 132, 227, 310, 340-341
Dietary Reference Intakes, 18, 125, 219, 227, 274, 327, 344, 347, 423.
See also Adequate Intakes, Estimated
Average Requirement;
Tolerable Upper Intake Level
Dietary sources of sodium, 1-2.
See also Levels of sodium in food supply;
Menus and menu items;
Processed foods
intake estimates by, 125-129, 137, 140-145
non-salt preservatives, 92, 94
Dietary supplements, 122, 123, 124, 134, 187, 276, 410, 411-413, 415, 419
Disappearance data, 55-56, 145-146
District of Columbia, 451, 462
Dough-conditioning agents, 97, 98, 99, 101, 102, 104, 105, 112
E
Economic Research Service, 57
Economic theory
consumer value associated with food, 194-196
household value associated with food preparation, 196-198
and sodium intake reduction, 193-198
Education. See Consumer education
Emergency Food Assistance Program, 185
Emulsifying agents, 98, 99, 101-102, 104-105, 106, 109, 110, 381
Emulsions, 84, 85, 86, 101
Energy intakes. See Calories
Environment. See Food environment
Epithelial sodium channels, 75-76, 328
Estimated Average Requirements, 226, 227, 328
European Union, 155, 241, 245, 359.
See also individual countries
Exeter-Andover study, 204
F
Farm Act legislation, 246, 247
Fast food.
See also Restaurant/foodservice oerations
children’s consumption of, 197
defined, 46, 331
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layering of high-salt items, 308
menu planning concerns, 178-179
monitoring, 147
nutrition disclosure, 460
portion sizes, 48, 198
recommended sodium reductions, 350
regulation of, 261
sales, 175, 176
sodium content of, 42-43, 101, 237-238
sodium intake densities of foods, 46, 143, 144, 145, 147
Fat, 44, 50, 52, 159, 186, 223, 228.
See also Saturated fats;
Total fats;
Trans fats
Federal Food, Drug, and Cosmetic Act, 8, 13, 214, 222 n.14, 223, 230, 261, 286-287, 303, 459
Federal food programs.
See also individual departments and agencies
leveraging sodium reduction in, 252-253, 290-291
military, 175, 176, 177, 184, 185, 188-189, 252, 290
National School Lunch Program and School Breakfast Program, 184-187
SNAP, 131, 184, 185, 187, 188, 252, 290, 413, 430
WIC, 34, 131, 184, 185, 188, 252, 290, 345, 413, 430
Federal Trade Commission (FTC), 12, 52, 224, 268, 295
Federation of American Societies for Experimental Biology, 217
Feeding Infants and Toddlers Study (FITS), 127, 128
Fermentation, 92, 93-94, 97, 104, 110, 111, 328
Fiber, dietary, 43, 44, 50, 53, 224, 228, 232, 270-271, 457, 459, 461, 463, 465
Finland, 239, 241, 242-243, 244, 359-361
Finnish Heart Association, 360
FINRISK survey, 360
Fish. See Seafood products
Flavor.
See also Taste
combining flavorings, 70, 84
cooking techniques and, 70
effects of salt on, 72-74, 82
enhancing agents, 5, 67, 73, 76, 85, 87, 98, 99, 103-106, 109, 110, 112-114, 168, 214, 220, 251, 260-261, 271, 289, 307, 312, 313, 329, 406, 407
importance in food acceptance, 2, 18, 69-71
research needs, 82
substitutes for salt, 84
taste as synonym for, 69
Florida, 462-463
Folic acid supplementation, 63, 203, 254-255
Food Additives Amendment, 214
Food and Agriculture Organization, 357
Food and Drug Administration (FDA), 18
categories for packaged foods, 299, 445, 446
Daily Values, 10, 218, 225-228, 269-270, 288-289, 327, 342, 366-367, 457
Food Labeling and Package Survey, 12, 50, 280, 295
food safety regulations, 8, 9, 12-13, 15, 36, 164, 169, 214, 215-221, 223, 254, 255, 256, 259, 260-261, 262, 275, 277, 286-287, 298, 303, 305-307, 310, 342, 343, 348, 350;
see also GRAS status
funding for, 311
guidance for small companies, 275
Health and Diet Surveys, 7, 39-41, 44
labeling requirements, 10, 33, 36-37, 42, 50, 173, 222-224, 225-226, 227, 228-229, 230-232, 239, 268-269, 273, 288-289, 301, 303, 338, 341, 342;
see also Nutrition labels/labeling
recommended strategies for, 8, 10, 12, 13, 15, 254, 255, 256, 259, 286-289, 293, 295, 299, 305-306, 310
summary of past activities and recommendations of, 30, 32-33, 341-344
Total Diet Study, 12, 38, 103, 112, 114, 145, 146-147, 277, 280, 295, 359
USDA liaison with, 13
Food and Drug Administration Modernization Act, 230
Food and Drugs Act of 1906, 214
Food and Nutrition Service, 184
Food composition databases, 137, 145, 147, 148, 295-296, 409, 412
Food, Conservation, and Energy Act, 246-247
Food Distribution Program on Indian Reservations, 185
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Food environment.
See also Processed foods
consumer interactions with, 62-63, 153, 190-204, 236
effectiveness of changes to, 254-255
federal food programs, 184-189
framework, 153-154
health behavior change embedded in, 202-204
manufacturing and retailing, 154-173
restaurant/food service foods, 173-184
state and local governments, 189-190
Food Guide Pyramid, 338
Food industry.
See also Processed foods;
Restaurant/foodservice operations
consumer education, 30, 34, 168, 170-172, 181-183
defined, 1, 24, 26
interest in developing lower sodium products, 8, 29, 50, 61, 63, 161
online health information sites, 34
past recommendations for actions by, 36-37
point-of-purchase information about sodium, 4, 24, 25, 26, 29, 36-37, 42, 61, 168, 172, 187, 193, 223, 225, 232, 236, 240-241, 268-273, 293, 459, 461
recommended strategies for, 10, 13, 287-288
research funding, 168, 169
response to public health initiatives, 4, 25, 36-37, 237-238
United Kingdom, 244-245, 364-365
voluntary reduction of sodium, 1, 4, 7, 10, 13, 25, 26, 29, 36, 168-170, 242, 287-288
Food Labeling and Package Survey, 12, 50, 280, 295
Food safety.
See also GRAS status;
Preservation of foods;
Regulation
acrylamide formation, 102
emerging technologies, 96, 97, 251-252
FDA authority, 8, 9, 12-13, 15, 36, 164, 169, 214, 215-221, 223, 254, 255, 256, 259, 260-261, 262, 275, 277, 286-287, 298, 303, 305-307, 310, 342, 343, 348, 350
GRAS options, 218-222, 275
microbial growth prevention, 91-93, 94, 95-96, 97, 105, 106, 109, 110, 112, 229, 251-252, 275, 314, 382, 391
multiple-hurdle methods, 92-93, 97, 106, 112
N-nitrosamines, 107
predictive models for new formulations, 97
reformulation challenges, 95-97, 102, 164-165, 274-275
shelf-life testing, 164, 275
United Kingdom, 95-96, 274-275
Food selections, changes in, 17
Food Stamps. See Supplemental Nutrition Assistance Program
Foodservice.
See also Fast food;
Food industry;
Menus and menu items;
Restaurants;
School foods defined, 173-174
France, 68, 241, 243, 245, 361-362
Fresh Fruit and Vegetable Program, 185
Fruits and fruit products, 21, 30, 63, 71, 94, 105, 110, 111, 114, 115, 140, 141, 143, 155, 159, 179, 181, 184, 185, 192, 196, 197, 224, 247, 266, 308, 315, 327, 328, 341, 376, 388, 389, 437
Functions of sodium additives in foods.
See also Physical properties of food;
Preservation of foods
beverages, 94, 114-115
confections, 113-114
dairy foods, 97-98, 100, 101, 102, 108-109, 112, 113
fruits, vegetables, beans, and legumes, 94, 105, 110-111, 112, 114, 115
grains, 103-105
mixed dishes, 111-112
muscle foods, 94, 95, 96, 97, 98, 100, 101, 102, 105, 106-107, 112
research needs, 100, 101
sauces, gravies, stocks, salad dressings, and condiments, 96, 98, 110, 112
savory snacks, 97, 113
and sodium content of similar foods, 100-101
G
Gender
and hypertension, 60, 61, 432
intakes of sodium by, 5, 57, 58, 59, 123, 124, 126, 128, 135-136, 138, 141, 418-421, 432-433, 438-441
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sodium intake density by, 6, 58, 59, 129, 130, 138, 139, 424-425
General Mills Inc., 34, 156, 170, 171
Glucono-δ-lactone, 102
Glutamic acid, 84, 329
Government
initiatives, see State and local governments;
individual federal departments and agencies
food programs, see Federal food programs;
State and local governments
public-private partnerships, 11, 15, 19, 32-33, 263, 288, 291, 293, 307, 309
Government Accountability Office (GAO), 187, 218
Grains and grain products.
See also Bakery/baked goods
breakfast cereals, 103-104, 141, 142, 159, 242, 344, 360, 364, 377, 435, 438, 439, 441, 442
functions of sodium additives, 103-105
intakes of sodium from, 140, 141, 142, 434, 435, 438, 442
iodine levels, 277
new products, 181
pasta, 104, 105, 140, 141, 142, 159, 182, 383, 385, 394, 434, 435, 438, 439, 440, 441, 442
rice, 72, 103, 104, 105, 112, 142, 159, 246-247, 384, 385, 395, 396, 434, 435, 439, 442
sodium content, 103, 104, 105, 265
value of shipments, 155
whole grains, 103, 181, 184
GRAS status
alteration or revocation process, 219-221, 262
exemption approach, 303-304
food category framework, 298-301
implementation of standards, 15, 221, 298-307
labeling options, 222, 301-303
modification, 169, 253-262, 298-307
monitoring and evaluation system, 257-259
overview, 216-218
petitions for reclassification, 217-218, 342
potential for changes, 253-262, 303-304
prior-sanctioned uses of salt and, 220-221, 261
process to alter or revoke GRAS status, 219-221
rationale for modification, 253, 254-255
recommendations, 8-9, 10-13, 286-287
restaurant/foodservice menu items, 10, 230-231, 259-260, 261, 286-287, 304-305
safety-based options, 218-222, 275
sodium-containing compounds other than salt, 287
sodium enhancement solutions, 220, 260-261
stepwise approach, 253-254, 255-257, 286, 301-303
Gravies, 110, 112, 142, 436
Grocery Manufacturers Association, 273
Guiding Stars Licensing Company, 444
H
Harvard School of Public Health, 181
Health and Diet Surveys, 7, 39-41, 44
Health behavior.
See also Consumer awareness and behaviors
beliefs and attitudes, 199
communication campaigns, 35, 199-201
embedded in food environment, 202-204
environmental barriers, 199
intention to change, 198-199
labeling/disclosure strategies, 201-202
perceived norms, 199
self-efficacy, 199, 201
theory applied to sodium intake reduction, 198-199
Health belief model, 198
Health Canada, 358
Health literacy, 61
HealthierUS School Challenge, 34, 186-187, 344
Healthy People, 337, 338, 410, 411-412
Heart disease, 1, 20, 21, 22, 23, 39, 40, 53, 136-137, 191, 199, 200-201, 267, 293, 326, 327, 349, 357, 362-363
Historical context for salt use, 68, 91, 214
Home. See At-home foods
Household Food Consumption Surveys, 409
Household production theory, 196-198
Hyperkalemia, 278, 279, 329
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Hypertension
age and, 60, 61, 132
behavior change interventions, 199, 293-294
consumer awareness of sodium/salt relationship to and health risks of, 39-40, 62, 191, 264-265
cost-effectiveness of sodium reductions, 21-22, 311
DASH Diet, 136, 237, 327
deaths, 21
definition, 60-61, 329, 413
dietary guidelines for persons with, 17, 119, 132, 219, 341
dose-response relationship, 23
gender and, 60, 61, 432
health consequences, 1, 20, 21
incidence, 17, 20, 35
income and, 61
intakes by at-risk groups, 132, 432
international policies, 358
INTERSALT study, 135-136
label health claims and advertising, 50, 53, 230, 231, 289
lifetime risk statistic, 21-22
messages to consumers, 35, 61, 191, 264-265, 292
outreach opportunities, 267
prevalence, 20-21, 37, 60-61, 62
prevention interventions and reports, 203, 338, 340, 341, 351
progressive nature of, 23
race/ethnicity and, 61, 132
risk factors, 20, 60, 61
salt substitutes and, 278
seriousness of public health problem, 20-22
societal and medical savings of reducing
hypertension, 22
surveillance, 409
trends, 6, 7, 20-21, 60-61, 62
World Hypertension Day, 33
I
Ice cream, 108, 109, 142, 436
Implementation of strategies
content changes in processed foods and menu items, 2-3, 307-309
funding, 310-311
GRAS status modification, 298-307
monitoring of, 255
outreach to consumers, 3, 309
time line, 310
Incentives to lower sodium
agricultural subsidies, 246-247
awards and recognition, 186-187, 344
cap and trade system, 246, 249-250
effectiveness of, 187
for food program participants, 290-291
label content and health claims, 29, 45, 50, 161, 224, 226, 240, 270, 271-272, 289, 343
point-of-purchase, 187, 271-273
restaurant/foodservice operations, 273, 290-291
in stepwise approach, 4, 25, 308
tax credits, 247-248
tax on foods, 5, 246, 248-249
Income, intakes by level, 131
Indiana, 463
Individuals, intakes by, 56-59
Industry. See Food industry
Infants
intakes of sodium, 127-128
salt in baby foods, 347
salt preference, 24, 78
Initiatives addressing sodium, by year and sponsor, 32-33
Institute of Medicine (IOM), 20, 30, 32-33, 119-120, 274
Intakes of sodium/salt.
See also Density of sodium intake;
Monitoring sodium intakes
age and, 5, 6, 57, 58, 59, 78-79, 123-124, 125-128, 130, 131, 132-133, 138, 141, 358, 418-433, 438-441
AIs, 10, 119-120, 126, 127, 226, 227, 269, 270, 288-289, 325, 327, 344, 347, 413, 420-423, 428, 430, 432
at-risk subpopulations, 119, 132-133, 135-136, 432-433
average daily, 1, 122
calcium deficiency and, 77
calorie intakes and, 6, 21, 45-46, 47, 49-50, 59, 128-129, 130, 137-140, 141-142, 143, 145, 266, 307-308, 309, 314, 315
CARDIA study, 136-137
by category of foods, 122, 140-141, 142-143, 414-415, 434-437
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characterizing sodium in food supply, 140-147, 414-415
consumer awareness, 38-40, 146, 201, 236, 269
current, U.S. population, 17, 20, 122-127, 410-413
estimating, 121-122, 409-415
food composition databases, 137, 145, 147, 148, 409
food sources, 59, 119, 122, 123, 124, 125-129, 134, 137, 140-145, 411, 418-419, 426-433, 438-441
gender and, 5, 57, 58, 59, 123, 124, 126, 128, 135-136, 138, 141, 418-421, 432-433, 438-441
home vs. away from home, 2, 35, 36, 44-45, 48-49, 82-84, 119, 123, 124, 132-133, 135-136, 141, 143-145, 411, 412, 414-415, 418-419, 432-433, 442
income and, 131, 413, 430-431
by individuals, 56-59
INTERMAP study, 136
international, 242, 244, 245, 358, 359, 360-361, 363, 367-368
INTERSALT study, 135-136
levels of sodium in foods and, 59
market basket study, 146-147
measurement approaches, 55-60, 122
medications, 122-123
NHANES analysis, 45, 47, 49, 56-59, 119, 120, 121, 122-133, 135, 136, 137-140, 147, 410-413
nonfood sources, 122, 123, 124, 133-134, 410, 411-413, 415, 419
nutrition labeling and, 37, 42-44, 56, 57, 146
overreporting/overestimation, 56, 121-122, 130
population-level or group, 17, 20, 121, 122-127, 410
portion sizes and, 45, 47-48
processed foods, 36
public health initiatives and, 5-8, 56, 61-63, 120, 146
race/ethnicity and, 129-131, 136-137, 413, 426-429
recommended maximum daily, 1, 56, 119, 124
relative contributions of sources, 47-50
sensory effects of lowering, 80-81
subpopulations of interest, 129-133, 413
from supplements (dietary), 122, 123, 124, 134, 410, 411-413, 415, 419
table salt, 2, 82-84, 123, 124, 133, 411, 412, 418-419
total, all sources, 47, 123, 420-421
trends over time, 5-8, 17, 56-59, 136, 137-140, 236, 414
ULs, 413, 420-421, 432-433
underreporting/underestimation, 57, 121-122, 136, 137, 410
urine analysis measures of, 134-137, 139-140
water sources, 123, 124, 133-134, 411
INTERMAP, 136
International Food Information Council, 41
International initiatives.
See also individual countries
components of, 241, 242, 243-244
and intakes of sodium, 242, 244, 245, 358, 359, 360-361, 363, 367-368
nutrition labeling, 159, 243-244, 245, 246, 360, 362, 363
scope of past activities, 30
International Society on Hypertension, 135
INTERSALT study, 135-136, 329
Iodine, 14, 148, 258, 259, 275-278, 281, 329
Ireland, 243, 362-363
Irish Heart Foundation, 363
Iron, 44, 107, 186, 188, 228, 457
J
Japan, 135, 136
Japanese Heart Foundation, 135
Jason’s Deli, 182
Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, 20, 31, 339
K
Kellogg Company, 34, 156, 171
Kentucky, 463
Kidney disease, 1, 21, 278, 326, 332, 340
Kraft Foods, Inc., 97, 156, 170
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L
Label claims. See Nutrition labels/labeling
Lactic acid bacteria, 93-94, 95
Leavening agents, 98, 99, 101, 102, 104, 112, 113
Left ventricular hypertrophy, 21, 329
Legumes. See Beans and legumes;
Fruits and fruit products;
Vegetables and vegetable products
Level playing field, 2, 8, 13, 224, 239, 241, 242, 255, 260, 287, 329
Levels of sodium in food supply
availability of lower-sodium products, 53-55
content of food, 45-47, 144, 146, 153
and intake trends, 59
label claims and advertising, 50-51
monitoring needs, 147, 280, 444, 467-468
preservatives, 100-101
public health initiatives and, 45-55
relative contributions of different sources, 47-50, 153
Life Sciences Research Office, 217
Listeria monocytogenes, 95, 96, 97, 112, 275
Listeriosis, 95
Lithium chloride, 75, 76, 405
Lower-sodium products
ad libitum salt use with, 82-84
availability, 8, 53-55, 146, 169, 170-171
challenges to introducing, 95-102, 164-165, 166-167, 179-181, 242, 274-275
consumer education, 168, 170-171
content claims, 8, 10, 29, 42, 50, 51, 52, 53, 54, 55, 62, 63, 161, 167, 168, 169, 192, 223-224, 228, 229, 230, 231-232, 240, 270, 271, 272-273, 289, 360
demand for, 8, 55-56, 167, 179, 183, 239
economic issues, 159, 166, 167, 179, 195
flavor substitutes, 84, 180
menu and menu item development, 71, 179-181
motivation to develop, 8, 29, 50, 61, 63, 161
organic products, 166
palatability, 80-81, 82, 166, 167, 168, 179, 180-181, 191-192, 194, 239, 242, 272
particle size and structure modifications, 84-85
physical properties, 98-102
promotion and introduction, 267-268, 275
restaurant/foodservice offerings, 182-183
safety and shelf-life issues, 95-97, 164, 166
sea salt use, 85
silent sodium reductions, 72, 81-82, 168-169, 171, 268
targeting for, 17
taste modification/manipulation, 8, 79-87, 238-239
tax incentives for, 247-248
voluntary industry efforts, 1, 4, 7, 25, 26, 146, 167-173, 237-238
M
Magnesium sulfate, 73, 405
Market basket studies, 148, 277.
See also Total Diet Study
Maryland, 345, 451, 461, 463
Mathematica Policy Research, 127
Mayo Clinic, 134
McCain, 183
McDonald’s, 175, 183, 237
Meats
brine injections, 96, 100, 101, 105
contribution to sodium intake, 140, 141, 142, 265, 360, 434, 438, 439, 440, 441, 442
fresh, 105, 214, 220, 224-225, 260-261, 271, 289
functions of sodium in, 94, 95, 96, 97, 98, 100, 101, 102, 105, 106-107, 112
iodine levels, 277
labeling, 224-225, 228, 271, 344
kosher, 107
new product introductions, 159, 170
preservatives, 214
processed, 80, 94, 95, 96, 97, 98, 100, 101, 102, 106-107, 112, 159, 170, 171, 275, 331, 344, 383, 402, 434
reduced sodium products, 170, 171, 251, 275, 344, 363
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regulation of, 220, 224-225, 289
sodium content of, 100
targets for salt reduction, 370-374, 383, 384, 385, 386, 390, 402
value of shipments, 155
Medications, 122-123, 278
Menu planning tools for consumers 31, 33-34, 266, 365
Menus and menu items
aggregation of high-sodium ingredients, 71, 180-181, 308
availability of ingredients, 180, 260
calories, 173, 179, 224, 232, 270-271, 459-466
categorizing, 448-449
challenges to introducing reduced sodium items, 179-181
for children, 182
cooking and flavoring strategies, 70, 181, 313
demand for health items, 181
development of, 71, 177-179, 189, 260, 291
education of food preparers, 180, 181, 260, 291, 304-305
food safety regulation, 230-231
GRAS status applied to, 10, 230-231, 259-260, 261, 286-287, 304-305
icons for healthy choices, 182
implementation of changes in, 2-3, 253, 304-305, 307-309
incentives for change, 247, 304-305
military, 189
monitoring sodium in, 148, 294, 296, 316
nutrition labeling and education, 10, 182, 223-232, 240-241, 270-271, 273, 289-290, 304, 459-466
pre-processed ingredients, 260, 271
sodium content, 237
state and local regulations, 232, 240-241, 345-346, 459-466
Mexican American, 130, 131, 413, 426-427
Mexico, 155
Microbial growth prevention, 92-93, 94, 95-96, 97, 105, 106, 109, 110, 229, 251, 275, 314, 382, 391
Military feeding programs, 175, 176, 177, 184, 185, 188-189, 252, 290
Mixed dishes
at-home preparation, 49, 153
combining higher and lower sodium foods, 70-71
estimating sodium in, 414
functions of sodium in, 111-112
intakes of sodium from, 49, 140-141, 142, 143, 434, 438
labeling, 242
lower-sodium products, 170, 183
new product introductions, 159
sodium content, 112
sources of sodium in, 144
Mock salts, 84
Moisture-retaining agents, 99, 100, 102
Monitoring and evaluation
consumer awareness and behavior, 280
GRAS modification, 257-259
implementation of strategies, 255
potassium, 258
salt preference changes in, 81
sodium content of foods, 147, 148, 259, 280-281, 294, 296, 316, 444, 467-468
strategies for reducing sodium, 203-204, 256-257, 259, 279-281
Monitoring sodium intakes
24-hour recalls, 56, 58-59, 62, 121, 122, 124, 134, 147, 148, 325, 410, 411, 412, 414, 448
disappearance data, 55-56, 57, 62, 121, 145-146, 327
expanding and enhancing, 294-296
recommendations, 294-296
restaurant/foodservice items, 148
UPC sales data linked to Nutrition Facts
Panel, 280, 444, 467-468
urinary sodium excretion, 11, 14, 59-60, 62, 68, 80, 83, 121, 134-137, 139-140, 147-148, 203, 245, 276, 279-280, 294-295, 315, 329, 339, 360, 363, 450
Monocalcium phosphate, 102
Monosodium glutamate, 84, 99, 329, 330, 406
Muscle foods. See Meats;
Seafood products
Myocardial infarction, 22
MyPyramid program, 31, 34, 266, 280, 293
N
N-Nitrosamines, 107
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National Health and Nutrition Examination Survey (NHANES), 17
data analysis methods, 409-415
hypertension prevalence from, 7, 61, 413
iodine levels, 276
Medical Examination Center, 61
overview, 409-410
sodium density data, 47
sodium intakes estimates from, 45, 47, 49, 56-59, 119, 120, 121, 122-133, 135, 136, 137-140, 147, 410-413, 448
National Heart, Lung, and Blood Institute (NHLBI), 18
FDA initiative with, 341
INTERMAP, 136
INTERSALT, 135
Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, 20, 31, 339
mission, 266
National High Blood Pressure Education Program, 30-31, 266-267, 293, 338, 339
past recommendations and initiatives, 32-33, 338-340
Prevent and Control America’s High Blood Pressure: Mission Possible, 340
National High Blood Pressure Education Program, 30-31, 266-267, 293, 338, 339
National Institutes of Health (NIH), 31
National Nutrient Database, 57, 114, 133
National Nutrition Monitoring and Related Research Program, 122
National Nutrition Monitoring System, 37, 62
National Research Council
reference values for nutrients, 226-227
summary of past reports and recommendations of, 30, 32-33, 347-348
National Restaurant Association, 173, 174, 176, 181
National Salt Reduction Initiative
approach, 299, 346, 444-449
categories of foods, 241, 245, 298, 299, 443-445, 446, 448-449
databases, 444, 448, 450
development of, 169, 241
monitoring and evaluation, 450
packaged food, 444-448
participating organizations, 241, 346, 443, 450-451
restaurant food, 448-449
targets, 241, 443, 445-448, 449, 450
National School Lunch and Child Nutrition Act Amendments, 186
National School Lunch Program and School Breakfast Program, 47, 184-187
New York City
National Salt Reduction Initiative, 169, 241, 246, 280, 299, 305, 346, 443-451
nutrition standards, 189-190
New York State, 451
Nestlé, 156, 169, 170
Neutralizing agents, 99
Nielsen Company, 444, 445, 447
Nongovernmental organizations, government partnerships, 32-33
North Karelia project, 359
NPD Group, 176, 448
Nutrient standards for private-label products, 159
Nutrition Facts Panel
changes to, 226-228, 288-289
Daily Value for sodium, 10, 218, 225-228, 269-270, 288-289, 327, 342, 366-367, 457
establishment, 224
example, 457
frequency of consumer use of, 42-44, 62
UPC sales data linked to, 280, 444, 467-468
Nutrition Labeling and Education Act (NLEA), 33, 36, 42, 50, 52, 222, 223-230, 231-232, 271, 272, 273, 289-290, 330
Nutrition labels/labeling.
See also Nutrition Facts Panel
background, 223-225
by category of foods, 50-51
content claims, 8, 10, 29, 42, 50, 51, 52, 53, 54, 55, 56, 62, 63, 146, 161, 167, 168, 169, 192, 223-224, 228, 229, 230, 231-232, 240, 270, 271, 272-273, 278-288, 289, 360
definitions of claims, 229, 231
exemptions, 231-232
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FDA requirements, 10, 33, 36-37, 42, 50, 173, 222-224, 225-226, 227, 228-229, 230-232, 239, 268-269, 273, 288-289, 301, 303, 338, 341, 342
frequency of industry use, 8, 54-55, 272
front-of-package, 172, 173, 245, 246, 268-269, 301, 363, 366-367
future of claims, 272
GRAS modification and, 222, 301-303
guidelines for, 224-225, 350
health claims, 8, 10, 29, 42, 45, 50-51, 52-53, 161, 173, 220, 223-224, 230, 231-232, 240, 271-273, 324, 342
“healthy” claim, 221, 228-229, 272, 342
“High Salt Content,” 360
implementation of recommended strategies, 301-303
incentive value to producers, 29, 45, 50, 161, 224, 226, 240, 270, 271-272, 289, 343
and intakes of sodium, 37, 42-44, 56, 57, 146
international, 159, 243-244, 245, 246, 360, 362, 363
“Low Salt,” 360
mandatory, 33, 36, 42, 50, 52, 56, 146, 159, 213, 222, 223-230, 231-232, 243, 271, 272, 273, 289-290, 291, 330, 342
NLEA requirements, 33, 36, 42, 50, 52, 222, 223-230, 231-232, 271, 272, 273, 289-290, 330
nutrients other than sodium, 8, 43, 50, 223, 229, 268-269, 457
percentage/number of products with, 42, 55
point-of-purchase information, 4, 24, 25, 26, 29, 36-37, 42, 61, 168, 172, 187, 193, 223, 225, 232, 236, 240-241, 268-273, 293, 459, 461
private label products, 159
reading and interpreting, 42-44, 191, 199, 201-202, 223, 225, 265, 268-271
recommendations, 10-11, 288-290
regulation, 223-230, 231-232, 291, 342
restaurant/foodservice menus, 10, 182, 223-232, 240-241, 270-271, 273, 289-290, 304, 459-466
and sales volume, 50, 51, 316, 342, 365, 444, 445-446, 467-468
shelf label claims, 173
single-ingredient raw products, 224-225, 271
standards for, 223-230, 288-289, 342
state and local initiatives, 232, 240-241
step-down approach, 272-273, 301-303
trends in use, 42-44, 50-51, 199
voluntary, 36-37, 42, 50, 168, 220, 223-225, 243-244, 245, 271, 360, 362, 363, 366-367
warning/disclosure statements, 201-202, 217, 222, 288-289
Nutrition Program for the Elderly, 185
Nutrition rating and scoring systems, 168, 172, 173, 182
Nutrition Services Incentive Program, 185
Nuts and seeds, 51, 113, 114, 143, 247, 328, 437
O
Obesity and overweight, 6, 20, 21, 30, 47, 61, 123, 182, 183, 224, 232, 248, 266, 350
Occupational Safety and Health Administration, 456
Office of Disease Prevention and Health Promotion, 18
Office of Management and Budget, 454, 455
Oklahoma, 464
Oregon, 345, 451, 461
Osteoporosis, 30, 53
P
Palatability of foods, 2, 15, 67, 68-69, 70, 71, 74, 79, 81, 82, 84, 91, 100, 192, 195, 239, 242, 256, 273, 311, 312, 313.
See also Flavor;
Salt taste
preference;
Taste
Pastas and noodles, 104, 105, 112, 140, 141, 142, 159, 182, 383, 384, 385, 394, 434, 435, 438, 439, 440, 441, 442
Patient Protection and Affordable Care Act, 224, 232, 270, 271, 459
Pennsylvania, 451, 464
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PepsiCo Inc., 156, 171
Philadelphia, nutrition initiatives, 345, 451, 460
Physical properties of food
alternatives of sodium containing compounds, 102
challenges and innovations for lowering sodium, 98-102
role of sodium, 97-98
sodium-containing compounds other than salt, 99
Point-of-purchase information, 4, 24, 25, 26, 29, 36-37, 42, 61, 168, 172, 187, 193, 223, 225, 232, 236, 240-241, 268-273, 293, 459, 461.
See also Nutrition labeling
Portion/serving size, 14, 45, 47-48, 49-50, 100, 179, 184, 190, 197-198, 260, 266, 291-292, 304, 308, 392
Potassium
adverse effects, 251, 259, 278, 279, 281, 329, 405
dietary guidelines, 86, 251, 278, 341
drug interactions, 278, 332
health claims, 230
and hypertension, 61
monitoring needs, 258
physiological role, 330
and salt sensitivity, 24
as salt substitute, 71, 73, 85, 86, 97-98, 251, 278-279, 307, 313, 330, 341, 405, 406
taste, 76, 313, 330
Potassium bicarbonate, 102
Potassium chloride, 71, 73, 85, 86, 97-98, 251, 278-279, 307, 313, 338, 341, 405, 406, 407
Potassium citrates, 102
Potassium-enriched Pansalt, 248, 360
Potassium glutamate, 73, 406
Potassium hydrogen tartrate, 104
Potassium lactate plus sodium diacetate, 97, 406
Potassium phosphates, 101, 102
Potassium sodium L-tartrate, 99
Predictive Microbiology, 314
Preservation of foods, 3.
See also Food safety;
Functions of sodium additives in foods
by category of food, 105, 106, 110, 112, 114
challenges and innovations for lowering sodium, 95-97
combining methods for, 92, 93
fermentation role, 92, 93-94, 97, 104, 110, 111, 328
historical context for salt use, 68, 91, 214
levels of sodium and, 100-101
microbial growth prevention, 91, 92-93, 94, 95-96, 97, 105, 106, 109, 110, 112, 229, 251, 275, 314, 382, 391
refrigeration, 91-92, 95, 96, 109
shelf-life extension, 91, 92, 95, 100, 105, 108
sodium-containing compounds other than salt, 91, 92, 94
Processed foods.
See also Food industry;
Reduced-sodium products
cap and trade system, 249-250
challenges to introducing reduced-sodium products, 166-167
economic value of shipments, 154, 155
efforts to reduce sodium, 167-173
expenditures by type of outlet, 158
imports, 155
industry characteristics, 154-159
intakes of sodium, generally, 36, 154
labeling, see Nutrition labels/labeling
manufacturing, 154-157, 159-166
new product introductions, 159, 169, 170-171
nutrition standards, 159, 169
packaging, 48, 92, 97, 112, 159, 164-165, 168, 171-172, 251-252, 381
private label products, 155-156, 159, 166, 288, 444, 446, 447, 468
product development process, 159-166
reformulated products, see Lower-sodium products
retailing, 157-159, 163, 166, 172
slotting fees, 158, 159, 166
top processors, 155, 156
top retailers, 158
Product development
business groups involved in, 159-161
concept development, 164
economic issues, 159, 163-164, 165, 166, 167
food safety considerations, 164-165
idea generation, 161-164
launch and produce, 165
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menus and menu items, 71, 177-179, 260
plan and design, 164-165
private label foods, 166
process steps, 159-166, 179
reformulated products, 161, 164-165, 167
smaller companies, 160, 161, 166
Professional organizations.
See also individual organizations
health professional training, 267
scope of past initiatives, 30
Protein, 186, 189, 223, 224, 232, 271, 459, 463, 465
Public health initiatives.
See also individual departments, agencies, and programs
and consumer awareness and behaviors, 37-45
consumer-oriented, 26, 37-45, 235-241
effectiveness, 1, 45-55, 61-63, 236, 238
and hypertension prevalence, 60-61
industry response to, 4, 25, 36-37, 237-238
and intakes of sodium, 1, 5-8, 17, 56, 61-63, 120, 146
international initiatives, 239-241, 246
lessons learned, 235-241, 242
and levels of sodium in food supply, 45-55, 236
linking sodium reduction programs to, 49-50
message to consumers, 35
outcomes, 37-61, 236
point-of-purchase information, 26, 36-37, 236
scope of past and current initiatives, 20, 26, 30, 32-33, 34, 336-346
Public-private partnerships, 11, 15, 19, 32-33, 263, 288, 291, 293, 307, 309
Q
QSR50, 448
Quinine hydrochloride, 73
R
Race/ethnicity, intakes by, 129-131, 136-137, 413, 426-429
Recommendations.
See also Strategies for sodium reduction
charge to committee, 19-20
committee approach, 3-5, 19-27, 235
context for, 5-8
development of, 24-27
implementation, 14-15
information gaps, 14-15
interim strategies, 10, 13-14, 285-286, 287-288
monitoring sodium intakes, 194-196
past, by year and sponsor, 30, 32-33
primary strategies, 8-9, 10, 12-13, 285, 286-287
scientific rationale for decisions, 19-24
statement of task, 18-19
supporting strategies, 10-12, 13-14, 286, 288-296
target population, 3, 20, 22-24
Recommended Dietary Allowances, 186, 226, 227, 327, 331, 347
Reduced-sodium products. See Lower-sodium products
Reduction of sodium in foods.
See also Incentives to lower sodium;
Lower-sodium products;
Public health initiatives;
Strategies for sodium reduction
adverse effects, 274
economic theory applied to, 193-198
challenges for processed food industry, 74, 95-97, 98-102, 166-167
competing nutrition priorities, 183-184
cost-effectiveness, 21-22, 166
food safety issues, 95-97, 251-252, 274-275
funding, 310-311
GRAS status of salt and, 169, 218-222, 253-262
health theory applied to, 198-199
implementation activities, 307-309
industry efforts, 1, 4, 7, 10, 13, 25, 26, 29, 36, 167-173, 242, 287-288
international initiatives, 169
and iodine insufficiency, 275-278
monitoring and evaluation, 259, 280-281
and physical properties of foods, 98-102, 251-252, 255
and potassium intake from salt substitute, 278-279
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and preservation of foods, 95-97
public health programs linked to, 49-50
public-private partnerships, 11, 15, 19, 263, 288, 291, 293, 307, 309
silent reductions, 72, 81-82, 168-169, 255
statutory mandates, 33
stepwise approach, 2-3, 72, 81-82, 186, 192, 194, 242, 252-254, 255-257, 272-273, 286, 301-303
time line for, 310
unintended consequences, 273-279, 280-281
Reference amount customarily consumed, 103, 105, 107, 108, 110, 111, 112, 113, 114, 115, 445
Refrigeration, 91-92, 95, 96, 109
Regulation.
See also GRAS status;
Nutrition labels/labeling;
individual statutes
of advertising, 224, 268, 341
approval process for food additives, 215-216
costs and benefits, 453
FDA jurisdiction, 8, 9, 12-13, 15, 36, 164, 169, 214, 215-221, 223, 254, 255, 256, 259, 260-261, 262, 275, 277, 286-287, 298, 303, 305-307, 310, 342, 343, 348, 350
GRAS substances, 216-217
new products, 164
nutrition labeling, 223-230, 231-232
resource and cost issues, 262
restaurant/foodservice operations, 230-232
rulemakings, 213, 219, 257-258, 342, 343, 344, 453-456
salt, 216-222, 227
school meals, 186
sodium-containing compounds other than salt, 222-223, 262, 287
state and local initiatives, 232
USDA jurisdiction, 220, 224-225, 228, 260-261, 268, 273, 289, 343, 344, 445
Renal. See Kidney disease
Research needs
monitoring and surveillance, 315-316
salt taste, 74, 311-313
sodium additives, 100, 101
sodium reduction in food, 313-314
supporting consumers, 314-315
Restaurant/foodservice operations.
See also Fast food;
Food industry;
Foodservice;
Menus and menu items;
Restaurants;
School food
chains, 176, 178-179, 180-181, 259, 261
commercial establishments, 174-176
contributions of sodium to doos supply, 259
distribution sector, 180
efforts to reduce sodium, 8, 181-184
implementation of recommendations, 304-305
independent, 176, 177-178, 259-260, 261, 270, 291
industry characteristics, 173-177
information sources for, 173, 175
institutional (noncommercial), 175, 176, 189-190
military, 175, 177, 189
perceptions of sodium intakes, 41-42
portion sizes, 198
production and delivery within food environment, 173-184
sales volume, 173, 176-177
standardized operations, 10, 176, 178, 179, 180-181, 259-260, 261, 263, 286, 287, 289-290, 304, 308
state and local foodservice operations, 189-190
top companies, 175
types, 174, 176-177
Restaurants.
See also Fast food;
Food industry;
Foodservice;
Menus and menu items
defined, 46, 176
sodium intake density of foods, 46, 145, 198
Rice and rice products, 72, 103, 104, 105, 112, 142, 159, 246-247, 384, 385, 395, 396, 434, 435, 439, 442
S
Salad dressings, 94, 96, 110, 142, 143, 144, 170, 197, 391, 436
Salt (sodium chloride)
distinguished from sodium, 24
sensitivity, 3, 18, 24, 331
sensory properties, 2
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Salt Institute, 56, 57
Salt need, 77
Salt preference.
See also Taste
age-related differences, 78-79
defined, 26, 77
early development of, 2, 23, 24, 35, 77-79
evolution of, 76-78, 236, 239
modification/manipulation in adults, 2, 79-87, 193, 239-240, 242, 258-259
monitoring changes in, 81
research needs, 78
source of foods and, 7, 47
Salt/sodium substitutes
applications, 8, 405-407
examples, 405-407
mixture with sodium chloride, 86, 407
potassium chloride, 71, 73, 85, 86, 97-98, 251, 278-279, 307, 313, 338, 341, 405, 406, 407
sea salt, 85, 251, 307, 332, 405, 412
sodium channel receptors and, 75
Salt taste
bliss point, 71-72
enhancers, 5, 76, 85, 87, 195
evolution of, 76-77
intensity, 71, 72, 87
Just Noticeable Difference, 81-82
mechanisms of, 75-76, 85
persistence, 71, 80-81
Sara Lee Corp., 156, 171
Saturated fat, 21-22, 30, 43, 44, 50, 52, 159, 184, 186, 224, 226, 228, 232, 269, 270-271, 327, 331-332, 366, 387, 457, 459-460, 461, 462, 463, 464, 465
Sauces and stocks, 96, 98, 110, 112, 140, 171, 182, 242, 360, 383, 385, 390-392, 394, 398, 434, 446
Savory snacks, 48, 97, 113, 141, 142, 159, 173, 190, 248, 387-388, 393
Scanner data, 157, 467, 468.
See also Universal Product Code
School foods
defined, 46
foodservice operations, 176
HealthierUS School Challenge, 34, 186-187, 344
lower-sodium offerings in, 182
National School Lunch and School Breakfast Programs, 47, 184-187, 344
recommendations, 252
regulation of nutrient content, 186, 190
sodium intake densities, 46, 47, 145
School Nutrition and Dietary Assessment Study (Third), 47, 127
Sea salt, 85, 251, 307, 332, 405, 412
Seafood products, 94, 98, 107, 144, 155, 177, 224, 242, 260, 271, 277, 289, 333, 360-361, 384, 385, 386, 390, 398, 400, 402, 415, 434, 442
Seattle and King County, nutrition initiatives, 345, 451, 459-60
Select Committee on GRAS Substances (SCOGS), 36, 217, 341
Serving size. See Portion serving/size
ServSafe program, 305
Shelf life of products, 91, 92, 95, 100, 105, 108, 164, 166, 258, 275, 313-314, 370
Snacks. See Savory snacks
Social cognitive theory, 198
Societies of Epidemiology, 451
Sodexo, 176, 183
Sodium acetate, 73, 74, 94, 99
Sodium acid pyrophosphate, 99, 102, 104
Sodium alginate, 99, 101, 109, 251
Sodium aluminum phosphate, 99, 102
Sodium ascorbate, 94, 106, 107, 119
Sodium benzoate, 94, 119, 332
Sodium bicarbonate, 98, 99, 102, 104, 119, 122, 332, 376
Sodium channel receptors, 75-76
Sodium citrates, 99, 102, 109
Sodium-containing compounds other than salt
bitterness of, 75
neutralizing agents, 73, 74, 94, 99
preservatives, 92, 94
Sodium content of food.
See also Levels of sodium in food supply
additives by category of food, 103-115
benchmark, 47
implementing changes in processed foods and menu items, 2-3, 307-309
label claims, 10, 29, 42, 50, 51, 52, 53, 54, 55, 62, 63, 161, 167, 168, 169, 192, 223-224, 228, 229, 230, 231-232, 240, 270, 271, 272-273, 289, 360
school lunches and breakfasts, 47
source of foods and, 45-47
trends, 236-238
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Sodium deficiency, 77
Sodium depletion, 78
Sodium diacetate, 94, 96-97
Sodium erythorbate, 94, 106, 107
Sodium hydrogen carbonate, 99, 102
Sodium metabisulfite, 99, 102, 105
Sodium nitrite, 94, 95, 106-107
Sodium phosphates, 94, 98, 99, 102, 109
Sodium stearoyl lactylate, 99, 104-105
Sodium tripolyphosphate, 98, 99, 101
Souplantation/Sweet Tomatoes, 183
Soups, 49, 72, 73, 111, 112, 153, 154, 159, 170, 183, 242, 331, 360, 386, 434, 438
Sous vide products, 96
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), 34, 131, 184, 185, 188, 252, 290, 345, 413, 430
Stabilizing agents, 99, 101, 110
Staphylococcus aureus, 96
State and local governments.
See also individual states
funding for cardiovascular disease prevention, 267, 293
nutrition standards, 189-190, 232, 240-241, 345-346, 459-466
“sin” takes, 248-249
summary of past activities and recommendations of, 30, 32-33
State Heart Disease and Stroke Prevention Program, 267, 293
Stocks. See Sauces
Strategies for sodium reduction. See Consumer education;
Implementation of strategies;
Public health initiatives;
Recommendations;
Reduction of sodium in foods;
Supporting strategies
combining higher and lower sodium foods, 70-71
comprehensive approach, 49-50, 63, 79-81, 202-204, 242
consumer oriented, 62, 168, 170-171, 190-192, 263-273
cooking techniques, 70
cost-effectiveness, 1, 247, 248, 357
folic acid example, 63, 203, 204, 254-255
food supply approach, 2, 63, 239-240, 242, 254-255, 263
in government food programs, 252-253
international experience, 30, 169, 239, 241-246, 357-368
lessons learned from past initiatives, 235-241
low-sodium foods with ad libitum salt use, 82-84, 257
model for population-wide reductions, 79-81
monitoring, 203-204, 256-257, 259, 279-281
particle size and structure modifications, 84-85
policy/regulatory changes, 202-204, 253-262
preservatives, 95-97
processing methods, 100, 101, 102-103, 111, 251-252
scope of past recommendations and initiatives, 30-37
sea salt, 85, 251
sensory approaches, 81-84, 250-251
substitutes and enhancers, 85-87, 168, 251
taste/flavor modification/manipulation, 70-71, 72, 79-87, 101, 203-204, 258-259
technological approaches, 74, 100, 102-103, 169-170, 250-252, 259
Stroke, 1, 20, 21, 22, 60, 62, 230, 241, 243, 326, 327, 332, 362-363
Subway, 183
Sugar substitutes, 51, 85, 87, 170, 222, 274-275, 331
Sugars, 7, 43, 44, 51, 52, 55, 73-74, 92, 94, 95, 103-104, 105, 155, 159, 186, 249, 275, 277, 329, 361, 366, 436, 457, 461, 463, 465
Summer Food Service Program, 185
Supplemental Nutrition Assistance Program (SNAP), 131, 184, 185, 187, 188, 252, 290, 413, 430
Supplements, dietary, 122, 123, 124, 134, 187, 276, 410, 411-413, 415, 419
Supporting strategies.
See also Nutrition labels/labeling;
Reduced-sodium products
point-of-purchase information, 4, 24, 25, 26, 29, 36-37, 42, 61, 168, 172, 187, 193, 223, 225, 232, 236, 240-241, 268-273, 293, 459, 461
reduction of sodium in processed foods, 1, 4, 25, 26, 29
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Surgeon General, recommendations and initiatives, 32-33, 337
Sysco, 180
T
Take-out foods, 173, 326, 328
Taste.
See also Flavor;
Salt preference;
Salt taste
bitter, 69, 71, 73-74, 75, 85, 86, 109, 251, 307, 313, 330, 332, 405, 406
qualities of, 69, 71
sour, 69, 104, 332, 406
sweet, 69, 70, 71, 72-73, 74, 85, 332
as synonym for flavor, 69
technical definition, 69
umami, 69, 84, 330, 333, 406
Tennessee, 451, 465
Texas, 465
Texture-modifying agents, 91, 97-98, 99, 101, 103, 104, 108, 109, 111, 112, 113, 378
Theory of reasoned action, 198
Thickening agents, 98, 99, 109, 373, 406
Tolerable Upper Intake Level, 18, 121, 125, 126, 127, 128, 227, 289, 327, 332, 344, 347, 358, 413, 420, 421, 422, 423, 426-433
Total Diet Study, 12, 38, 103, 112, 114, 145, 146-147, 277, 280, 295, 359
Total fat, 43, 44, 186, 226, 327, 366, 457, 461, 463
Trans fat, 21, 44, 183-184, 265, 305, 457, 460, 461, 462, 463
Transglutaminase, 101
Trials of Hypertension Prevention, 203
Trials of Nonpharmacologic Interventions in the Elderly, 203
U
Ultrafiltration, 100
Unilever, 156, 171, 238
United Kingdom
awareness campaign, 244, 366
food category framework, 245, 298, 299, 370-403, 444-445, 446
food industry involvement, 244-245, 364-365
labeling initiatives, 245, 246, 366-367
impact of salt reduction program, 244, 245, 367-368, 446
intakes of sodium, 242, 245, 367-368
INTERMAP study, 135
microbial safety of food products, 95-96, 274-275
nutrient standards for private-label products, 159
recommended sodium intakes, 363
Salt Reduction Campaign, 169, 241-242, 244-245, 298, 299, 363-403, 443
target salt reductions by food category, 244-245, 370-403, 446
Universal Product Code (UPC), linking to Nutrition Facts label, 280, 444, 467-468
Urine analysis, measurement of sodium intakes, 11, 14, 59-60, 62, 68, 80, 83, 121, 134-137, 139-140, 147-148, 203, 245, 276, 279-280, 294-295, 315, 329, 339, 360, 363, 450
U.S. Department of Agriculture.
See also Dietary Guidelines for Americans;
National Health and Nutrition Examination Survey
categories for packaged foods, 445
Child and Adult Care Food Program, 185
Commodity Distribution Program, 34, 185-186, 252, 344, 345
Commodity Supplemental Food Program, 185
Diet and Health Knowledge Surveys, 39-40, 41, 43, 44, 201
Economic Research Service, 57
Emergency Food Assistance Program, 185
Food and Nutrition Service, 184
Food Assistance for Disaster Relief, 185
food composition database, 145, 295-296, 409, 412
Food Distribution Program on Indian Reservations, 185
Food Guide Pyramid, 338
foodservice information, 173, 175
Fresh Fruit and Vegetable Program, 185
funding for strategies, 311
HealthierUS School Challenge, 34, 186, 344
Household Food Consumption Surveys, 409
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MyPyramid program, 31, 34, 266, 280, 293
National Nutrient Database, 57, 114, 133
National School Lunch Program, 184-187
Nutrition Program for the Elderly, 185
Nutrition Services Incentive Program, 185
Predictive Microbiology website, 314
regulatory authority, 185, 217-218, 220, 224-225, 228, 260-261, 268, 273, 289, 343, 344, 445
School Breakfast Program, 184-187
SNAP, 131, 184, 185, 187, 188, 252, 290, 413, 430
summary of past activities and recommendations of, 30, 32-33
Summer Food Service Program, 185
supporting strategies recommended for, 10, 11, 12, 13, 288-289, 294, 295-296
WIC program, 34, 131, 184, 185, 188, 252, 290, 345, 413, 430
U.S. Department of Commerce, 154
U.S. Department of Defense, 185, 188-189
U.S. Department of Education, 18
U.S. Department of Health and Human Services, 18.
See also Dietary Guidelines for Americans;
individual agencies
past recommendations and initiatives, 32-33
recommendations to, 3
U.S. Department of Justice, 185
U.S. Department of Labor, 18, 185, 346, 456
U.S. Department of Veterans Affairs, 185
U.S. Environmental Protection Agency, 454
U.S. Foodservice, 180
U.S. Public Health Service, 32-33
U.S. Senate Select Committee on Nutrition and Human Needs, 30, 32-33, 337
V
Vegetables and vegetable products, 21, 30, 63, 71, 84, 94, 110, 111, 112, 114, 140, 141, 142, 147, 155, 159, 179, 181, 184, 185, 192, 196, 197, 224, 247, 266, 308, 315, 327, 328, 333, 341, 345, 361, 384, 385, 386, 390, 399, 400, 403, 406, 434, 435, 440, 441, 446.
See also Beans and legumes
Vending machine foods, 145, 184, 190, 326, 350, 413
Vermont, 465-466
W
Wal-Mart, 100, 157, 158, 149, 468
Washington State, 451
Water
activity of foods, 74, 92, 93, 95, 104, 105, 106, 109, 113, 333
sodium sources, 114, 115, 123, 124, 133-134, 411
West Virginia, 451, 454
White House Conference on Food, Nutrition, and Health, 5, 30, 32-33, 235, 336
Whites, non-Hispanic, 130, 131, 136-137, 413, 426-427
World Action on Salt and Health, 32-33, 351
World Cancer Research Fund (WCRF), 32-33, 351
World Health Organization (WHO), 30, 32-33, 135, 348, 357
World Hypertension Day, 33, 351
World Hypertension League, 32-33, 351, 451
World Salt Awareness Week, 33, 351
Worlds of Healthy Flavors conference, 181
Y
Yersinia enterocolitica, 96
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