TABLE B-1 Government Initiatives
Date |
Program/Initiative/Report Title |
Recommendations/Initiatives/Actions |
Target Population (if specified) |
White House Conference |
|||
1969 |
Conference on Food, Nutrition, and Health: Final Report (White House Conference, 1969) |
Provided advice on the desirability of reducing sodium intake |
Hypertensive individuals |
|
|
Encouraged food processors to minimize the amount of salt in processed foods |
Food processors |
|
|
Identified a need for food labeling of sodium |
|
U.S. Senate—Select Committee on Nutrition and Human Needs |
|||
1977 |
Dietary Goals for the United States, 2nd edition (Select Committee on Nutrition and Human Needs, 1977) |
Decrease salt intake to about 5 g/d |
All Americans |
U.S. Department of Health and Human Services—Centers for Disease Control and Prevention (CDC) |
|||
2009 |
The Congressional Omnibus Appropriations Acta (2009) included language encouraging CDC to work with major food manufacturers and chain restaurants to reduce sodium content in their products and to submit to the Committee on Appropriations and the House of Representatives and the Senate an evaluation of its sodium-reduction activities within 15 months of enactment of the act, and annually thereafter |
CDC plans to explore existing national and international public and private initiatives to reduce sodium in the food supply In fiscal years 2009–2010, CDC plans to convene public and private stakeholders to build relationships and partnerships to investigate approaches for reducing sodium consumption CDC will explore knowledge gaps, utilizing its data systems to analyze and release pertinent sodium related data (CDC, 2009) |
Food manufacturers and chain restaurants |
U.S. Department of Health and Human Services—Surgeon General |
|||
1979 |
Healthy People: Surgeon General’s Report on Health Promotion and Disease Prevention (Public Health Service, 1979) |
Consume less salt; cook with only small amounts of salt, avoid adding salt at the table, avoid salty prepared foods |
All Americans |
1988 |
Surgeon General’s Report on Nutrition and Health (Public Health Service, 1988) |
Reduce intake of sodium by choosing foods relatively low in sodium and limiting the amount of salt added in food preparation and at the table |
All Americans |
U.S. Department of Health and Human Services—Public Health Service |
|||
1980 |
Promoting Health and Preventing Disease: Objectives for the Nation (Public Health Service, 1980) |
By 1990:
|
All Americans |
1990 |
Healthy People 2000 (NCHS, 2001) |
Increase % of persons preparing foods without adding salt from 43% (baseline) to a target of 65% Increase % of persons rarely or never using salt at the table from 60% (baseline) to 80% Increase % of persons regularly purchasing foods with reduced salt and sodium content from 20 (baseline) to 40% |
All Americans |
2001 |
Healthy People 2000 Review (NCHS, 2001) |
During the mid-1990s, overall the percent of persons rarely or never using salt at the table ranged from 56–62%, and the % of persons regularly purchasing foods with reduced salt and sodium content was 19% |
All Americans |
Date |
Program/Initiative/Report Title |
Recommendations/Initiatives/Actions |
Target Population (if specified) |
2000 |
Healthy People 2010 (HHS, 2000) |
Increase the percentage of persons who consume ≤ 2,400 mg/d sodium from baseline (21% based on the National Health and Nutrition Examination Survey [NHANES] 1988–1994) to 65% (only 13% met target in 2003–2004 [Public Health Service, 2008]) |
Persons 2 or more years of age |
U.S. Department of Health and Human Services—National Heart, Lung, and Blood Institute (NHLBI), the National Institutes of Health |
|||
1972 |
National High Blood Pressure Education Program (NHLBI, 2010) |
Cooperative effort among professional and voluntary health agencies, state health departments, and many community groups with the goal to reduce death and disability related to high blood pressure through programs of professional, patient, and public education |
All Americans |
1993 |
Working Group Report on Primary Prevention of Hypertension (National High Blood Pressure Education Program) (Whelton et al., 1993) |
Reduce salt intake to no more than 6 g per day |
All Americans |
1995, 1999 |
Statement from the National High Blood Pressure Education Program Coordinating Committee (NHLBI, 1999) |
Moderate salt and sodium intake Establish 2,400 mg/d sodium as a national dietary goal |
|
1996 |
Workshop: Implementing Recommendations for Dietary Salt Reduction: Where Are We? Where Are We Going? How Do We Get There? (NHLBI, 1996) |
Develop public and professional education activities within the primary prevention campaign to convey the rationale for and benefits of lowering dietary salt/sodium for hypertension prevention to the appropriate target audiences The salt/sodium messages must be consistent with and often integrated into overall healthful lifestyle diet messages, such as the Dietary Guidelines, USDA Food Guide Pyramid, and FDA food labels |
|
|
|
Experiences with intervention studies should be transferred to clinical and/or community settings after reviewing or evaluating and adapting, if necessary, strategies, methods, and materials Gradual “silent” or “transparent” lowering of salt or sodium in the food supply will need to occur along with the opportunity for effective marketing strategies and the promotion of reduced-sodium as well as low-sodium, low-salt, and no-salt food products. These recommendations are applicable to the food production industry, as well as restaurant, catering, and foodservice industries Data from completed clinical trials should be analyzed for the adequacy of simpler methods (e.g., casual urine collections, chloride titrator strips) as measures of sodium intake and for the validity of dietary recalls in order to consider the best feasible methods for individual and national-level assessments of sodium intake Other research needs identified in the areas of food technology; basic mechanisms of salt taste; and knowledge, attitudes, and skills of the public |
|
1997 |
The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (NHLBI, 1997) |
Reduce sodium intake to ≤ 100 mmol/d (2,400 mg sodium or 6 g sodium chloride) |
|
2002 |
National High Blood Pressure Education Program (update of 1993 report) (NHLBI, 2002) |
Reduce dietary sodium intake to no more than 100 mmol/d (approximately 2,400 mg of sodium or 6 g of sodium chloride) |
All Americans |
2003 |
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (NHLBI, 2004) |
Reduce sodium intake to no more than 100 mmol/d (2,400 mg sodium or 6 g sodium chloride) |
|
Date |
Program/Initiative/Report |
Title Recommendations/Initiatives/Actions |
Target Population (if specified) |
2005 |
Prevent and Control America’s High Blood Pressure: Mission Possible (NHLBI with CDC and the American Heart Association [AHA] as supporting partners; 22 states participated) (NHLBI, 2005) |
Promoted awareness and education materials to help the public health community attract new partners and revitalize relationships with existing partners to fight high blood pressure |
Persons at high risk for hypertension |
|
States distributed materials to public health departments; hospitals and clinics; schools; senior centers; refugee centers; faith-based organizations; work sites; primary care practices; emergency medical service groups; state health benefit plans; and disease-related organizations, such as diabetes, kidney failure, and cancer groups |
Low-SES (socioeconomic status) and minority populations |
|
2006 |
NIH Radio (NIH, 2006) |
Produced a broadcast-ready public service announcement about fighting high blood pressure through diet |
All Americans |
U.S. Department of Agriculture and U.S. Department of Health and Human Services (USDA/HHS) |
|||
1980 |
Dietary Guidelines for Americans (USDA/HHS, 1980) |
Avoid too much sodium |
“Most Americans” |
1985 |
Dietary Guidelines for Americans (USDA/HHS, 1985) |
Avoid too much sodium |
“Most Americans … those who are already healthy” |
1990 |
Dietary Guidelines for Americans (USDA/HHS, 1990) |
Use salt and sodium only in moderation |
Healthy Americans 2 or more years of age |
1995 |
Dietary Guidelines for Americans (USDA/HHS, 1995) |
Choose a diet moderate in salt and sodium. “The Nutrition Facts Label lists A Daily Value of 2,400 mg” |
Healthy Americans 2 or more years of age |
2000 |
Dietary Guidelines for Americans (USDA/HHS, 2000) |
Choose and prepare foods with less salt |
Healthy Americans 2 or more years of age |
2005 |
Dietary Guidelines for Americans (USDA/HHS, 2005) |
Consume < 2,300 mg/d of sodium (~1 tsp salt) Choose and prepare foods with little salt, and consume potassium-rich foods, such as fruits and vegetables |
Americans 2 or more years of age |
|
|
Individuals with hypertension, African Americans, and middle-aged and older adults: Aim to consume no more than 1,500 mg/d of sodium, and meet the potassium recommendation (4,700 mg/d) with food |
High-risk populations |
2010 |
Dietary Guidelines for Americans |
Convened expert Advisory Committee to update the Dietary Guidelines for Americans for the year 2010. Sodium intake is included as a topic area for discussion (results pending) |
|
U.S. Food and Drug Administration (FDA) |
|||
1973 |
Food labeling (HHS/FDA, 1973) |
Required specific format when a nutrition claim was made in labeling or advertising or when a nutrient was added to a food Better information about the sodium content of foods was an early focus |
|
1979 |
Evaluation of the health aspects of sodium chloride and potassium chloride as food ingredients (SCOGS, 1979) |
Consumption of sodium chloride should be reduced Guidelines should be developed for restricting salt in processed foods The sodium content of processed foods should be labeled |
|
1981 |
Initiative with NHLBI (Derby and Fein, 1995) |
Educate the public about sodium Encourage manufacturers to display the sodium content on food labels |
|
Date |
Program/Initiative/Report Title |
Recommendations/Initiatives/Actions |
Target Population (if specified) |
1982 |
Rejected petitions requesting reclassification of salt’s status from “GRAS” (generally recognized as safe) to “food additive” and the addition of warning labels to highsodium foods and salt packets by deferring action on GRAS status of salt (HHS/FDA, 1982) |
Deferred action pending assessment of the impact of
Indicated that a voluntary program would produce the desired results with less regulatory burden and affirmed that the food industry was in the best position to reduce sodium levels in processed foods and should be given a chance to do so |
|
1984 |
Sodium labeling (HHS/FDA, 1984) |
Sodium added to mandatory list of nutrients to be declared on food labels Defined the terms for sodium content claims |
|
1993–2005 |
Nutrition Labeling Final Rules (HHS/FDA, 1993a,b,c, 1994, 2005) |
Established a Daily Value (DV) of 2,400 mg for sodium labeling Mandated declaration of sodium content on all foods (mg and % DV) Established labeling rules:
|
|
2005 |
Final rule regarding sodium levels in foods labeled as “healthy” (HHS/FDA, 2005) |
Retained 1993 level of ≤ 480 mg sodium per serving; eliminated requirement that this level drop to ≤ 360 mg Rationale:
|
|
2007 |
Public hearing in response to a 2005 petition (CSPI, 2005) requesting rulemaking regarding salt and a House of Representatives’ Committee on Appropriations 2005 statement encouraging the agency to focus on ways—both voluntary by the food industry and regulatory by FDA and USDA—to reduce salt in processed and restaurant foods (HHS/FDA, 2007a) |
The petition specifically requested FDA to
Issues discussed—GRAS vs. food additive status:
Issues discussed—food labeling:
|
|
Date |
Program/Initiative/Report Title |
Recommendations/Initiatives/Actions |
Target Population (if specified) |
2007 |
Advanced Notice of Proposed Rulemaking (ANPR): Nutrition Labeling (HHS/FDA, 2007b) |
Requested comments on questions including:
|
|
2007 |
Public Hearing (HHS/FDA, 2007c) |
Discussed: use of symbols to communicate nutrition information, consideration of consumer studies and nutrition criteria |
|
U.S. Department of Agriculture (USDA) |
|||
1993 |
Nutrition Labeling (USDA, 1993) |
Adopted similar food labeling provisions as FDA for USDA-regulated products (notably meat and meat products) |
|
1995 |
Commodity Distribution Program (provides 15–20% of school lunch program foods) |
Recommended specific sodium reductions for 10 commodity food categories in USDA’s Commodity Distribution Program: canned beef, pork, poultry, luncheon meat, refried beans, salmon, tuna, ready-to-eat cereals, ham, and carrots Excluded many other products due to the assumption that school children would find modifications unacceptable (USDA, 1995) |
Children consuming school meals |
2004 |
HealthierUS School Challenge (encourages elementary, middle, and high schools to improve the nutrition content of foods provided to children and youth) (FNS, 2010) |
Rewards changes in the school nutrition environment, including providing lower-sodium foods to all children and youth:
|
Children and youth consuming school meals |
2007 |
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (provides vouchers to participants for the purchase of specific food items to meet nutritional needs) (USDA/FNS, 2007) |
Requires that in certain food categories, foods must be lower in sodium or not have added sodium to qualify as a product that can be purchased with WIC vouchers |
Low-income, nutritionally at-risk, pregnant and postpartum women; infants and children up to 5 years |
2008 |
Commodity Distribution Program (FNS, 2008) |
Plans to purchase low-sodium canned vegetables with the goal to reduce sodium levels of all canned vegetables to ≤ 140 mg per serving by school year 2010 |
Children consuming school meals |
State and Local (Sodium Labeling Initiatives)b |
|||
2008 |
California |
Requires restaurant chains with ≥ 20 outlets statewide to disclose sodium information at point of sale |
|
2008 |
King County (Seattle) |
Requires posting of sodium content on menus for restaurant chains with ≥ 15 outlets nationwide or $1 million in annual sales (collectively for the chain); if a menu board is used, nutrition information (including sodium) must be provided at point of ordering |
|
2008 |
Philadelphia |
Requires posting of sodium content on menus for restaurant chains with ≥ 15 outlets nationwide |
|
2009 |
Montgomery County (Maryland) |
Requires restaurant chains with ≥ 20 outlets nationwide to disclose sodium information (in writing) on the premises, upon request |
|
2009 |
Oregon |
Requires restaurant chains with ≥ 15 outlets nationwide to provide sodium information on the premises, upon request |
|
Date |
Program/Initiative/Report Title |
Recommendations/Initiatives/Actions |
Target Population (if specified) |
Government/Non-government Organization Partnership |
|||
2009 |
National Salt Reduction Initiative (see Appendix G) |
Partnership of over 45 cities, states, and national health organizations working to reduce U.S. population salt intake by 20% over 5 years by working with industry to set salt reduction targets that are designed to allow for gradual reductions in the sodium content of packaged and restaurant foods |
U.S. population |
aPublic Law 111-8, Joint Explanatory Statement: Division F—Labor, Health and Human Services, and Education, and Related Agencies Appropriations, 2009. bImplemented or passed into law as of February 16, 2010. See Appendix J for more information. NOTE: d = day; g = gram; mg = milligram; tsp = teaspoon. |
TABLE B-2 Past Recommendations from the National Academies and the World Health Organization
Date |
Program/Initiative/Report Title |
Recommendations/Initiatives/Actions |
Target Population (if specified) |
The National Academies |
|||
1970 |
Safety and suitability of salt for use in baby foods (NRC, 1970) |
Recommended ≤ 0.25% salt be added to commercial baby food |
Infant food manufacturers |
1980 |
Toward Healthful Diets (NRC, 1980a) |
Use salt in moderation; adequate but safe intakes are considered to range between 3–8 g/d salt (1,200–3,200 mg/d sodium) |
|
1980 |
Recommended Dietary Allowances, 9th ed. (NRC, 1980b) |
Estimated Safe and Adequate Daily Dietary Intake of sodium: 1,100–3,300 mg |
Adults |
1989 |
Recommended Dietary Allowances (NRC, 1989a) |
Estimated minimum requirements for sodium of 500 mg/d |
Healthy persons ≥ 10 years of age |
1989 |
Diet and Health: Implications for Reducing Chronic Disease Risk (NRC, 1989b) |
Limit total daily intake of salt (sodium chloride) to ≤ 6 g, although ≤ 4.5 g would probably confer greater health benefits Limit use of salt in cooking and avoid adding it to food at the table Salty, highly processed salty, salt-preserved, and salt-pickled foods should be consumed sparingly |
|
2005 |
Dietary Reference Intakes for Sodium (IOM, 2005) |
Established Adequate Intake:
Established Upper Limit:
|
|
TABLE B-3 Past Recommendations from Health Professional Organizations
Date |
Program/Initiative/Report Title |
Recommendations/Initiatives/Actions |
Target Population (if specified) |
American Heart Association (AHA) |
|||
1973 |
Diet and Coronary Heart Disease (AHA, 1973) |
Moderate sodium intake |
|
1986 |
Dietary Guidelines for Healthy American Adults (AHA, 1986) |
Consume no more than 3,000 mg/1,000 kcal/d sodium |
Adults |
1988 |
Dietary Guidelines for Healthy American Adults (AHA, 1988) |
Consume no more than 3,000 mg/d sodium |
Adults |
1996 |
Dietary Guidelines for Healthy American Adults (Krauss et al., 1996) |
Consume no more than 6 g/d salt (2,400 mg/d) |
Adults |
1998 |
Dietary Electrolytes and Blood Pressure (Kotchen and McCarron, 1998) |
Consume ≤ 6 g/d salt |
Adults |
2000 |
Dietary Guidelines (Krauss et al., 2000) |
Limit salt intake to 6 g/d, ~100 mmol/d of sodium |
General population |
2006 |
Diet and Lifestyle Recommendations (Revision) for CVD Risk Reduction (Lichtenstein et al., 2006) |
Choose and prepare foods with little salt “In view of the available high-sodium food supply and the currently high levels of sodium consumption, a reduction in sodium intake to 1,500 mg/d (65 mmol/d) is not easily achievable at present. In the interim, an achievable recommendation is 2,300 mg/d (100 mmol/d)” Information dissemination program |
Adults and children over 2 years of age |
Date |
Program/Initiative/Report Title |
Recommendations/Initiatives/Actions |
Target Population (if specified) |
2006 |
Alliance for a Healthier Generation (joint initiative of AHA and the William J. Clinton Foundation) (Alliance for a Healthier Generation, 2009) |
Established voluntary nutrition guidelines (based on the 2005 Dietary Guidelines and AHA’s 2006 Diet and Lifestyle Recommendations) for competitive school foods (e.g., foods in vending machines) as part of its goal to reduce prevalence of childhood obesity; leading industry groups have signed on |
|
American Medical Association |
|||
1979 |
Concepts of Nutrition and Health (Council on Scientific Affairs, 1979) |
Moderate intake of salt to less than 12 g/d (4,800 mg/d sodium) |
|
2006 |
Report of the Council on Science and Public Health (Dickinson and Havas, 2007; Havas et al., 2007) |
Recommended a stepwise, minimum 50% reduction in sodium in processed foods, fast food products, and restaurant meals over the next decade; recommended that FDA revoke GRAS (generally recognized as safe) status of salt |
|
American Dietetic Association |
|||
2007 |
Nutrition Fact Sheets and web page (www.eatright.org) |
Provided sodium guidance on the meaning of sodium label claims and food purchasing or preparation techniques to reduce sodium intake |
|
American Public Health Association |
|||
2002 |
Policy Statement: Reducing sodium content in the American diet (APHA, 2002) |
Urged manufacturers to reduce the sodium content of processed foods by 50% over the next decade at a suggested rate of 5% per year |
|
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