Plenary VI
Sodium: Actions and
Insights from National
Forum Members and
Stakeholders
National Salt Reduction Initiative
- Elizabeth Leonard, MPH, Project Coordinator,
New York City Department of Health and Mental
Hygiene www.nationalforum.org
@NatForumHDSP

Elizabeth Leonard
Nutrition Strategy Program
Bureau of Chronic Disease Prevention and Tobacco Control
New York City Department of Health and Mental Hygiene
October 9, 2013

• Partnership of 95+ city and state health authorities and national health organizations
• Voluntary sodium targets following 100+ meetings with industry
• Almost 30 companies committed to NSRI targets
Decrease sodium content in foods by
25% over 5 years
Decrease population sodium intake by 20% over 5 years
Reduce risk of heart attack and stroke – the leading cause of death in US

Source: Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, et al. (2009) The Preventable Causes of Death in the United States: Comparative Risk Assessment of
Dietary, Lifestyle, and Metabolic Risk Factors. PLoS Med 6(4). b. Effect of high dietary salt on cardiovascular diseases was estimated through its measured effects of systolic bp.c. Protective effects of alcohol use on cardiovascular diseases are its net effects. Regular moderate alcohol use is protective for IHD, ischemic stroke, and diabetes but any use is hazardous for hypertensive disease, hemorrhagic stroke, cardiac arrhythmias, and other cardiovascular diseases.

Processed and restaurant foods
77%
Naturally occurring
12%
While eating
6%
Home cooking
5%
Mattes, RD. Donnelly D. Relative Contributions of Dietary Sodium Sources. Journal of American College Nutrition , 1991, 10:383-393.

Finland
• Requires high salt warnings for products that exceed a category-specific level, beginning in the 1990s
United Kingdom
• Coordinated voluntary national effort with sodium targets across 80 food categories for 2008 and 2010
• 50+ commitments from all sectors of industry, future planning underway
Australia
• Food and Health Dialogue is currently releasing targets by category, on a rolling basis
Pan American Health Organization / World Health Organization
• Established an Expert Group that developed recommendations to reduce population-wide dietary salt intake

• Primary recommendation: mandatory limits on sodium
• Interim recommendation: coordinated voluntary approach

State & City Health Departments
State Health Department
State Health Association
City or County Health
Department
State & Local Associations
• Association of State and Territorial Health Officials
• Association of State and Territorial Public Health
Nutrition Directors
• California Conference of Local Health Officers
• Council of State and Territorial Epidemiologists
•
Mississippi Task Force on Heart Disease and Stroke
Prevention
• Missouri Activity for Activity and Nutrition
• National Association of Chronic Disease Directors
Health Organizations
•
Academy of Nutrition and Dietetics (ADA)
• American College of Cardiology
• American College of Epidemiology
• American Heart Association
• American Medical Association
•
American Public Health Association
• American Society of Hypertension
• Association of Black Cardiologists
• Consumers Union
• Health Power for Minorities (Health Power)
• InterAmerican Heart Foundation
• International Society on Hypertension in Blacks
• Kaiser Permanente
• National Forum for Heart Disease and Stroke
Prevention
• National Hispanic Medical Association
• National Kidney Foundation
• Partnership for Prevention
• Preventive Cardiovascular Nurses Association
• Public Health Law Center at William Mitchell
College of Law
•
Society for the Analysis of African-American Public
Health Issues
• World Hypertension League
• National Association of County and City Health Officials
• New York State Chapter, American College of Cardiology
• Northern Illinois Public Health Consortium
• Northwest Kidney Centers
• South Carolina Institute of Medicine & Public Health
• Texas Association of Local Health Officials
• Texas Medical Association
• Texas Salt Reduction Collaborative
• Wisconsin Heart Disease and Stroke Alliance

• Built Databases: Contains nutrition and sales data for thousands of packaged and restaurant foods
• Analyze Databases : Collecting this data exposed the variation of sodium across similar products
Whole Wheat Bread
480mg sodium
3X amount of sodium
Whole Grain Bread
160mg sodium

• Set Targets: Sodium targets set for 2012 and
2014 for each of the 62 packaged food and 25 restaurant food categories
• Invite Commitments : 28 food companies are committed to the NSRI
• Monitor changes: Analyze changes in sodium in foods over time

2014
400 mg
2012
480 mg
Mean
530 mg

Packaged Food
•
Butterball
• Furmano Foods
•
Goya Foods
• Heinz
• Ken’s Foods
• Kraft Foods
Restaurant Food
• Au Bon Pain
•
Starbucks
•
Subway
• Uno Chicago Grill
•
LiDestri Foods/ Francesco Rinaldi
•
Mars Food
•
McCain Foods
• Mondelēz International
•
Red Gold
• Snyder’s-Lance
• Unilever
• White Rose
Food Retailers
• Delhaize America
• FreshDirect
•
Target Corporation

• Track changes in sodium content of packaged and restaurant food in 2012 and 2014 using:
‒ Packaged and Restaurant Food Databases
‒ Industry-reported data
• Implement baseline and follow up 24-hour urinary evaluation

1.
Track changes in sodium content of packaged and restaurant food
2.
Invite companies to commit to 2014 targets
3.
Expand NSRI partnership through continued collaboration with national health organizations, cities, and states and continued coordination with federal agencies

Elizabeth Leonard eleonard1@health.nyc.gov