Initiatives to Reduce Hypertension in the United States: Sodium Reduction in the Food Industry
Creators: name: Geralnick, Jackie
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2011

description: Sodium is an important mineral for both food production and human health. In the food supply, sodium plays many roles including taste, flavor, texture, functionality and food safety. In the body, sodium is necessary to maintain proper fluid balance. However, excess sodium intake has been correlated with increased blood pressure and hypertension, which is a risk factor for cardiovascular disease, the leading cause of death in the United States. The 2010 Dietary Guidelines for Americans recommend that healthy individuals consume a maximum of 2,300 mg of sodium per day, and individuals who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease limit their sodium intake to 1,500 mg/day. Despite these recommendations, the Institute of Medicine estimated that Americans consume an average of 3,400 mg/day based on NHANES data from 2003-06. In response to evidence that Americans consume excessive levels of sodium, many public health organizations are calling for a government intervention in the amount of sodium in the food supply. Approximately 77% of the sodium in American diets comes from packaged foods and foods purchased outside of the home. This is considerably more than the sodium that naturally occurs in foods (12%), and the amount that consumers add during cooking (5%) and eating (6%). In the last several years, there have been voluntary efforts involving the food industry to decrease sodium in their products, including the sodium reduction project led by the Grocery Manufacturers Association and the National Sodium Reduction Initiative led by the health department in New York City. Despite voluntary reformulations, the Institute of Medicine released a report, Strategies to Reduce Sodium Intake in the United States, which recommended that “the Food and Drug Administration (FDA) should expeditiously initiate a process to set mandatory national standards for the sodium content of foods” and “the food industry should voluntarily act to reduce the sodium content of foods in advance of the implementation of mandatory standards.” With the staggering prevalence of hypertension and cardiovascular disease in the US, industry-wide sodium reduction is estimated to decrease the incidence of hypertension and prevent numerous cardiovascular events, such as heart attacks and strokes. Proponents of this effort believe this intervention could save hundreds of thousands of lives and billions of dollars in health care costs. Opponents of sodium reduction believe that this will not be an efficacious strategy. As demonstrated through consumer surveys and market research, reducing sodium intake is not a concern of the average consumer and many consumers do not think lower sodium products taste good. If consumers do not purchase the reformulated products based on lack of awareness or motivation or poor taste perception, the strategy may do little to decrease sodium intake. Additionally, the efficacy of a population-wide intervention has not yet been proven and the evidence linking sodium to hypertension is inconclusive. Finally, opponents note that other dietary interventions may be more beneficial than efforts targeting sodium and there is some evidence indicating a sodium reduction to the level recommended in the 2010 Dietary Guidelines for Americans could actually cause more harm than good. A population-wide sodium reduction intervention is an important step in the right direction to improve the prevalence of hypertension but cannot be considered the magic bullet to prevent adverse health outcomes. For this intervention to be successful there needs to be a coordinated effort among industry, government, and public health organizations. First, government officials and public health advocates should work with consumers to ensure that they understand the significance of sodium reduction and provide motivation for consumers to purchase lower sodium products. With increased demand for low-sodium products, the industry will be encouraged to reformulate their recipes to reduce the sodium content in a way that is acceptable to consumers. Meanwhile, research should continue to investigate the relationship between sodium and hypertension and monitor the relationship between sodium reductions and health outcomes. Through this type of coordinated effort, public education and industry-wide sodium reduction may save thousands of lives and billions of dollars in health care costs.