Potential impact on U.S. sodium intake when voluntary sodium standards are applied for commercially processed and prepared foods

What is already known?

Approximately 9 in 10 people in the United States consume more sodium than the limits set in the 2015–2020 Dietary Guidelines for AmericansExternal, increasing their risk of high blood pressure. The limit is 2,300 milligrams (mg) per day for people 14 years or older and lower for children 2–13 years old. In 2013–2014, the average daily sodium intake for U.S. individuals 2 and older was 3,409 mg. Strong evidence has indicated that reducing blood pressure reduces the risks of heart disease and stroke, and reducing sodium intake decreases blood pressure.

In the United States, most dietary sodium comes from processed and restaurant foods rather than from salt that is added at the table or during home preparation and cooking. This prompted the Institute of Medicine (IOM)External to recommend mandatory national standards for the sodium content of these foods, with voluntary food standards recommended as an interim strategy. Voluntary standards to decrease the sodium content of commercially processed and prepared foods were published by New York City’s National Salt Reduction Initiative (NSRI)External for the United States in 2009 and by Health CanadaExternal in 2012.

What does this article add?

This is the first published analysis of the potential impact on U.S. sodium intake of applying published voluntary sodium standards for commercially processed and prepared foods overall and for sociodemographic and health subgroups. The analyses were based on NSRI 2009 baselines and 2014 targets and on Health Canada’s 2009–2010 baselines and 2016 benchmarks. Reductions in U.S. sodium intake were predicted based on mean sodium targets or benchmarks.

The results suggest:

  • Substantial reductions in average daily sodium intake could occur if the NSRI standards or Health Canada benchmarks were applied:
    • Using the NSRI targets, mean usual daily sodium intake was predicted to decrease by 698 mg.
    • Using Health Canada’s benchmarks, mean usual daily sodium intake was predicted to decrease by 615 mg.
    • People with higher sodium intake and potentially higher risk of high blood pressure might benefit more.
  • The proportion of adults ages 19 or older who consume at least 2,300 mg of sodium per day (exceeding the Dietary Guidelines limit) would decline from 88% to 71% if NSRI targets were applied and from 88% to 74% if Health Canada benchmarks were used.
  • The reduction of sodium in commercially processed and prepared foods, in line with established North American standards, could substantially decrease average sodium intake and the number of people consuming excess sodium.
Current Sodium Intake and Projected Sodium Intake with NSRI and Health Canada Targets Applied
Table showing Current Sodium Intake and Projected Sodium Intake with New York City’s National Salt Reduction Initiative (NSRI) and Health Canada Targets Applied. 88% of US Adults consumed less than 2,300mg of salt per day; 74% was reported from Health Canada; and 88% was reported from NSRI.

What are the implications of these findings?

  • Applying voluntary sodium standards to processed foods could significantly reduce sodium intake.
  • The data in this study could potentially inform projections of the health impact and the cost of setting sodium targets or benchmarks for commercially processed and prepared foods.

Citation

Cogswell ME, Patel SM, Yuan K, Gillespie C, Juan W-Y, Curtis CJ, et al. Modeled changes in U.S. sodium intake from reducing sodium concentrations of commercially processed and prepared foods to meet voluntary standards established in North America: National Health and Nutrition Examination SurveyExternal. Am J Clin Nutr 2017;106(2):530–40.