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Strategies to Reduce Dietary Sodium Intake

  • Prevention (L Sperling, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Excess sodium intake has an important, if not predominant, role in the pathogenesis of elevated blood pressure, one of the most important modifiable determinants of cardiovascular disease (CVD). In the United States, almost 80 % of sodium in the diet comes from packaged and restaurant foods. Given the current food environment, educational efforts such as clinician counseling are useful, but a comprehensive public health approach is necessary to achieve meaningful reductions in sodium intake. A successful approach includes several key strategies, which together will both promote positive decisions by individuals and change the context in which they make those decisions. The strategies include 1) public education, 2) individual dietary counseling, 3) food labeling, 4) coordinated and voluntary industry sodium reduction, 5) government and private sector food procurement policies, and 6) FDA regulations, as recommended by the Institute of Medicine, to modify sodium’s generally regarded as safe (GRAS) status. Population-wide reduction in sodium intake has the potential to substantially reduce the public burden of preventable CVD and reduce health care costs.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Institute of Medicine. Strategies to Reduce Sodium Intake in the United States. Washington, D.C.: National Academy Press; 2010. This report recommends key strategies to reduce population sodium intake in the US. The primary recommendation is that the US Food and Drug Administration regulate levels of sodium chloride (salt) in food by altering the GRAS (Generally Recognized as Safe) status of sodium. In addition, the report contains a comprehensive overview of the issues related to sodium reduction, including scientific evidence for sodium reduction, current sodium intake levels in the US, the role of salt and sodium in taste preferences and food science, and the US regulatory environment.

    Google Scholar 

  2. Bertino M, Beauchamp GK, Engelman K. Long-term reduction in dietary sodium alters the taste of salt. Am J Clin Nutr. 1982;36:1134–44.

    PubMed  CAS  Google Scholar 

  3. Mattes RD, Donnelly D. Relative contributions of dietary sodium sources. J Am Coll Nutr. 1991;10:383–93.

    PubMed  CAS  Google Scholar 

  4. United States Department of Agriculture, Center for Nutrition Policy and Promotion. United States Dietary Guidelines for Americans, 2010. Available at www.dietaryguidelines.govAccessed on September 20, 2011.

  5. Lloyd-Jones D, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovacular health promotion and disease reduction. The American Heart Association’s strategic impact goal through 2020 and beyond. Circulation. 2010;121:586–613.

    Article  PubMed  Google Scholar 

  6. Bernstein AM, Willett WC. Trends in 24-h urinary sodium excretion in the United States, 1957–2003: a systematic review. Am J Clin Nutr. 2010;92:1172–80.

    Article  PubMed  CAS  Google Scholar 

  7. New York City Department of Health and Mental Hygiene. Health Department announces new company commitments to National Salt Reduction Initiative; Sodium study confirms that New Yorkers eat too much salt. Available at http://www.nyc.gov/html/doh/html/pr2011/pr005-11.shtml. Accessed December 22, 2011.

  8. Lawes CM, Vander Hoorn S, Rodgers A, et al. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371:1513–8.

    Article  PubMed  Google Scholar 

  9. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–52.

    Article  PubMed  CAS  Google Scholar 

  10. Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.

    Article  PubMed  Google Scholar 

  11. Appel LJ, Brands MW, Daniels SR, et al. Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension. 2006;47:296–308.

    Article  PubMed  CAS  Google Scholar 

  12. He FJ, Macgregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens. 2008;23:363–84.

    Article  PubMed  Google Scholar 

  13. Sacks FM, Campos H. Dietary therapy in hypertension. N Engl J Med. 2010;362:2102–12. This article uses a case study of a patient with hypertension to address best practices for management of hypertension through diet. The authors provide specific dietary recommendations for patients, including sodium reduction, adoption of the DASH diet, and weight loss. The scientific evidence upon which dietary recommendations are based and guidance on how to counsel patients to adopt a healthier life style are also included.

    Article  PubMed  CAS  Google Scholar 

  14. Institute of Medicine. Dietary reference intakes: water, potassium, sodium chloride, and sulfate. 1st ed. Washington, DC: National Academy Press; 2004.

    Google Scholar 

  15. Bibbins-Domingo K, Chertow GM, Coxson PG, et al. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med. 2010;362:590–9. Through rigorous modeling, this study estimates the impact of population salt reduction on cardiovascular disease, mortality, and health care costs. It is projected that reducing population salt intake by 3 g per day will prevent, annually, between 44,000 and 92,000 deaths; 60,000 to 120,000 new coronary heart disease cases; and 32,000 to 66,000 strokes.

    Article  PubMed  CAS  Google Scholar 

  16. Cook NR, Cutler JA, Obarzanek E, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ. 2007;334:885.

    Article  PubMed  Google Scholar 

  17. Appel LJ, Frohlich ED, Hall JE, et al. The importance of population-wide sodium reduction as a means to prevent cardiovascular disease and stroke: a call to action from the American Heart Association. Circulation. 2011;123:1138–43. In this American Heart Association report, the argument is made for action to reduce population sodium intake in the US. It includes a review of the scientific evidence linking sodium intake to increased blood pressure as well as the potential benefits of addressing this public health problem.

    Article  PubMed  Google Scholar 

  18. Frohlich ED, Varagic J. The role of sodium in hypertension is more complex than simply elevating arterial pressure. Nat Clin Pract Cardiovasc Med. 2004;1:24–30.

    PubMed  CAS  Google Scholar 

  19. He FJ, Marciniak M, Visagie E, et al. Effect of modest salt reduction on blood pressure, urinary albumin, and pulse wave velocity in white, black, and Asian mild hypertensives. Hypertension. 2009;54:482–8.

    Article  PubMed  CAS  Google Scholar 

  20. Lin PH, Ginty F, Appel LJ, et al. The DASH diet and sodium reduction improve markers of bone turnover and calcium metabolism in adults. J Nutr. 2003;133:3130–6.

    PubMed  CAS  Google Scholar 

  21. Appel LJ. The case for population-wide salt reduction gets stronger. BMJ. 2009;339:b4980.

    Article  PubMed  Google Scholar 

  22. Stolarz-Skrzypek K, Kuznetsova T, Thijs L, et al. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA. 2011;305:1777–85.

    Article  PubMed  CAS  Google Scholar 

  23. O’Donnell MJ, Yusuf S, Mente A, et al. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA. 2011;306:2229–38.

    Article  PubMed  Google Scholar 

  24. Whelton PK. Urinary sodium and cardiovascular disease risk: informing guidelines for sodium consumption. JAMA. 2011;306:2262–4.

    Article  PubMed  CAS  Google Scholar 

  25. Webster JL, Dunford EK, Hawkes C, et al. Salt reduction initiatives around the world. J Hypertens. 2011;29:1043–50.

    Article  PubMed  CAS  Google Scholar 

  26. UK Food Standards Agency. UK salt reduction initiatives. Available at http://www.food.gov.uk/multimedia/pdfs/saltreductioninitiatives.pdf. Accessed December 21, 2011.

  27. New York City Department of Health and Mental Hygiene. Cutting salt, improving health: NYC salt media campaign 2010. Available at http://www.nyc.gov/html/doh/html/cardio/cardio-salt-ads.shtml. Accessed December 21, 2011.

  28. Lazar K. Mass. ad campaign aims to drive down salt consumption. The Boston Globe. September 30, 2011, 2011. Available at http://www.nyc.gov/html/doh/html/cardio/cardio-salt-ads.shtml. Accessed December 21, 2011.

  29. New York City Department of Health and Mental Hygiene. National Salt Reduction Initiative—Statement of commitment by health organizations and public agencies. Available at http://www.nyc.gov/html/doh/html/cardio/cardio-salt-coalition.shtml. Accessed December 22, 2011.

  30. Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, phase II. The Trials of Hypertension Prevention Collaborative Research Group. Arch Intern Med. 1997;157:657–667.

  31. Whelton PK, Appel LJ, Espeland MA, et al. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA. 1998;279:839–46.

    Article  PubMed  CAS  Google Scholar 

  32. Appel LJ, Champagne CM, Harsha DW, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA. 2003;289:2083–93.

    Article  PubMed  Google Scholar 

  33. Cabezas C, Advani M, Puente D, et al. Effectiveness of a stepped primary care smoking cessation intervention: cluster randomized clinical trial (ISTAPS study). Addiction. 2011;106:1696–706.

    Article  PubMed  Google Scholar 

  34. Appel LJ, Clark JM, Yeh HC, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011;365:1959–68.

    Article  PubMed  CAS  Google Scholar 

  35. Graves G. White noise.l Vogue. New York: Conde Nast; 2010.

    Google Scholar 

  36. Appel LJ, Miller ER. Promoting lifestyle modification in the office setting. In: Egan BM, Basile JN, Lackland DT, editors. Hypertension: hot topics. Philadelphia: Hanley & Belfus, Inc.; 2004. p. 155–63.

    Google Scholar 

  37. Rothman RL, Housam R, Weiss H, et al. Patient understanding of food labels: the role of literacy and numeracy. Am J Prev Med. 2006;31:391–8.

    Article  PubMed  Google Scholar 

  38. Todd, Jessica E. Variyam, Jayachandran N. The decline in consumer use of food nutrition labels, 1995–2006. Economic Research Report. Economic Research Service, U.S. Dept of Agriculture; 2008;63. Available at http://www.ers.usda.gov/Publications/ERR63/ERR63.pdf. Accessed October 30, 2011.

  39. Variyam JN. Do nutrition labels improve dietary outcomes? Health Econ. 2008;17:695–708.

    Article  PubMed  Google Scholar 

  40. Pietinen P, Valsta LM, Hirvonen T, et al. Labelling the salt content in foods: a useful tool in reducing sodium intake in Finland. Public Health Nutr. 2008;11:335–40.

    Article  PubMed  Google Scholar 

  41. UK Food Standards Agency. Front of pack traffic light signpost labeling: technical guidance. November 2007;Issue 2. Available at http://www.food.gov.uk/multimedia/pdfs/frontofpackguidance2.pdf. Accessed December 21, 2011.

  42. Sacks G, Rayner M, Swinburn B. Impact of front-of-pack ‘traffic-light’ nutrition labelling on consumer food purchases in the UK. Health Promot Int. 2009;24:344–52.

    Article  PubMed  Google Scholar 

  43. Institute of Medicine. Examination of front-of-package nutrition rating systems and symbols: promoting healthier choices. Washington, D.C.: National Academies Press; 2011.

    Google Scholar 

  44. Neuman W. Food makers devise own label plan. The New York Times. January 24, 2011. Available at http://www.nytimes.com/2011/01/25/business/25label.html?_r=2. Accessed December 23, 2011.

  45. Center for Science in the Public Interest. Salt assault: brand name comparisons of processed foods, 2nd Edition. Washington, DC: Center for Science in the Public Interest; 2008. Available at http://www.cspinet.org/new/pdf/salt_report_update.pdf. Accessed December 21, 2011.

  46. New York City Department of Health and Mental Hygiene. Cutting salt, improving health. Available at http://www.nyc.gov/html/doh/html/cardio/cardio-salt-initiative.shtml. Accessed December 22, 2011.

  47. Bertino M, Beauchamp GK, Engelman K. Increasing dietary salt alters salt taste preference. Physiol Behav. 1986;38:203–13.

    Article  PubMed  CAS  Google Scholar 

  48. Beauchamp GK, Bertino M, Engelman K. Failure to compensate decreased dietary sodium with increased table salt usage. JAMA. 1987;258:3275–8.

    Article  PubMed  CAS  Google Scholar 

  49. UK Department of Health. Public Health Responsibility Deal: pledges. Available at http://www.dh.gov.uk/en/Publichealth/Publichealthresponsibilitydeal/Pledges/index.htm. Accessed December 23, 2011.

  50. New York City Department of Health and Mental Hygiene. Cut the salt. Get the facts. The National Salt Reduction Initiative. Available at http://www.nyc.gov/html/doh/downloads/pdf/cardio/cardio-salt-nsri-faq.pdf. Accessed December 22, 2011.

  51. Strom S. Nonprofit advocate carves out a for-profit niche. The New York Times. June 17, 2010. Available at http://www.nytimes.com/2010/06/18/us/politics/18berman.html?pagewanted=all. Accessed February 8, 2012.

  52. The Center for Consumer Freedom. NY health chief summer-salts into the bland. Available at http://www.consumerfreedom.com/2009/01/3816-ny-health-chief-summer-salts-into-the-bland/. Accessed December 23, 2011.

  53. Salt Institute. New York City risks its greatest culinary achievement. Available at http://www.saltinstitute.org/News-events-media/Salt-Sensibility/Food/New-York-City-risks-its-greatest-culinary-achievement. Accessed December 23, 2011.

  54. New York City Department of Health and Mental Hygiene. New York City Food Standards. Available at http://www.nyc.gov/html/doh/html/cardio/cardio-vend-nutrition-standard.shtml. Accessed December 23, 2011.

  55. New York City food standards. Part I: Standards for meals/snacks purchased and served, revised October 2011. Available at http://www.nyc.gov/html/dycd/downloads/pdf/City_Agency_Food_Standards.pdf. Accessed December 23, 2011.

  56. Nutrition and Physical Activity Obesity Initiative, Bureau of Community Heath Access and Promotion, MA Department of Public Health. Massachusetts State Agency food standards: requirements and recommendations. Available at http://www.mass.gov/eohhs/docs/dph/com-health/nutrition-phys-activity/eo509-state-agency-food-standards.pdf. Accessed December 23, 2011.

  57. Centers for Disease Control and Prevention. Improving the food environment through nutrition standards: a guide for government procurement. U.S. Department of Health and Human Services, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention,; February 2011. Available at http://www.cdc.gov/salt/pdfs/dhdsp_procurement_guide.pdf. Accessed December 23 2011.

  58. Department of Health and Human Services, Food and Drug Administration, Department of Agriculture, Food Safety and Inspection Service. Approaches to reducing sodium consumption; establishment of dockets; request for comments, data, and information. Federal Register. Washington, D.C.: United States Government Printing Office; September 15, 2011;76(179):57050–57054.

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Acknowledgments

Laura Cobb is funded by the T32HL007024 Cardiovascular Epidemiology Institutional Training Grant from NIH/NHLBI and by the Johns Hopkins Bloomberg School of Public Health Department of Epidemiology. Cheryl Anderson receives grant support from National Heart Lung and Blood Institute, Grant Number K01HL092595.

Disclosure

L.K. Cobb worked on the National Salt Reduction Initiative (NSRI) as an employee of the New York City Department of Health and Mental Hygiene from March 2009 to July 2011. C.A. Anderson and L.J. Appel currently receive funding from the McCormick Science Institute to conduct a study with the objective of assisting the general public in achieving and maintaining the currently recommended sodium intake of 1,500 mg/day through a reduced sodium intervention that emphasizes spices and herbs.

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Authors and Affiliations

  1. Welch Center for Prevention, Epidemiology and Clinical Research, 2024 East Monument Street, Suite 2-600, Baltimore, MD, 21287, USA

    Laura K. Cobb MS, Lawrence J. Appel MD, MPH & Cheryl A. M. Anderson PhD, MPH, MS

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  1. Laura K. Cobb MS
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  2. Lawrence J. Appel MD, MPH
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  3. Cheryl A. M. Anderson PhD, MPH, MS
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Correspondence to Cheryl A. M. Anderson PhD, MPH, MS.

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Cobb, L.K., Appel, L.J. & Anderson, C.A.M. Strategies to Reduce Dietary Sodium Intake. Curr Treat Options Cardio Med 14, 425–434 (2012). https://doi.org/10.1007/s11936-012-0182-9

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