www.nationalforum.org@NatForumHDSP

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

Insights from the National Salt Reduction Initiative

Elizabeth LeonardNutrition 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

NSRI Overview 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

National Salt Reduction Initiative Deaths Attributable to Total Effects of Individual Risk Factors

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.

-

50,0

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50,0

00

150,

00 0

25

0,00 0

35

0,00 0

450,

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Mattes, RD. Donnelly D. Relative Contributions of Dietary Sodium Sources. Journal of American College Nutrition, 1991, 10:383-393.

Most Salt Intake Comes from Processed Foods

Home cooking

Naturally occurringProcessed

and restaurant

foods77%

12%

While eating6%

5%

International Attention to SaltFinland• 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

Institute of Medicine published report on Strategies to Reduce Sodium Intake in 2010:

• Primary recommendation: mandatory limits on sodium

• Interim recommendation: coordinated voluntary approach

US Context

State Health DepartmentState Health AssociationCity or County Health Department

State & City Health Departments

NSRI Partners Across U.S.• 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

•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

• 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

State & Local Associations

Health Organizations

Determining Baseline Sodium Levels

• 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

Whole Grain Bread

160mg sodium3X amount of

sodium

NSRI Strategy

• 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

2012 480 mg

2014 400 mg

Mean 530 mg

Category Sodium Distribution

Packaged Food •Butterball•Furmano Foods•Goya Foods•Heinz•Ken’s Foods•Kraft Foods•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

21 Companies Met 2012 NSRI Targets

Restaurant Food• Au Bon Pain• Starbucks• Subway• Uno Chicago Grill

How We Assess Progress• 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

Next Steps for the NSRI

Thank You

Elizabeth Leonard

eleonard1@health.nyc.gov