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Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

Suggested Citation:"Index." Institute of Medicine. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press. doi: 10.17226/12818.
×

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

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

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

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