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Chicago Section IFT Technical Session
Salt Reduction & its Impact on Health
and Wellness
Dominican University, Oct 21, 2011
John Ruff , President Elect , IFT
Sodium Reduction
� Why ?
� Who ?
� Where ?
� When ?
� How ?
© 2011 Institute of Food Technologists
IOM Committee On Strategies To
Reduce Sodium Intake� JANE E. HENNEY (Chair), College of Medicine, University of Cincinnati, OH
� CHERYL A. M. ANDERSON, Bloomberg School of Public Health, The Johns Hopkins
University, Baltimore, MD
� SONIA Y. ANGELL, New York City Department of Health and Mental Hygiene, New
York, NY
� LAWRENCE J. APPEL, School of Medicine, The Johns Hopkins University, Baltimore,
MD
� GARY K. BEAUCHAMP, Monell Chemical Senses Center, Philadelphia, PA
� RONETTE R. BRIEFEL, Mathematica Policy Research, Washington, DC
� MARSHA N. COHEN, Hastings College of the Law, University of California, San
Francisco
� CHRISTINA A. MIRELES DEWITT, Oklahoma State University, Stillwater
� GREG DRESCHER, The Culinary Institute of America, St. Helena, CA
� MARY K. MUTH, RTI International, Research Triangle Park, NC
� ROBERT J. RUBIN, School of Medicine, Georgetown University, Washington, DC
� JOHN RUFF, Winnetka, IL
� GLORIAN SORENSEN, School of Public Health, Harvard University, Boston, MA
� ELIZABETH A. YETLEY, Upper Marlboro, MD3 Source IOM Sodium Report 2010
Reviewers
� Armand V. Cardello, U.S. Army Natick Soldier R,D&E Center, Natick,
� Nancy M. Childs, St. Joseph's University, Philadelphia, PA
� Robert Earl, Grocery Manufacturers Association, Washington, DC
� John D. Floros, The Pennsylvania State University, State College
� Karen Glanz, University of Pennsylvania, Philadelphia
� Deanna M. Hoelscher, University of Texas Health Science Center at Houston
� Daniel W. Jones, University of Mississippi, Oxford
� Eileen T. Kennedy, Tufts University, Boston, MA
� Barbara K. Rimer, The University of North Carolina at Chapel Hil
� l Dwight Riskey, PepsiCo (retired), Plano, TX
� William B. Schultz, Zuckerman Spaeder LLP, Washington, DC
� Frances H. Seligson, Nutrition Consultant, Hershey, PA
� Walter Willett, Harvard School of Public Health, Boston, MA4 Source IOM Sodium Report 2010
Perspectives of the Food Industry and Food Service
Moderator: John Ruff, M.A., Committee Member
� Chor San Khoo, Ph.D., Vice President of Global Nutrition and Health, Campbell Soup Company
� Todd Abraham, Ph.D., Vice President of Global Nutrition, Kraft Foods
� Douglas Balentine, Ph.D., Director of Nutrition Sciences for the Americas, Unilever
� Deanne Brandstetter, M.B.A., R.D., Vice President of Nutrition and Wellness, Compass Group North America
� Stephanie Rohm Quirantes, M.S., R.D., L.D/N., Nutrition Manager, North America, Burger King
� Elizabeth Johnson, M.S., R.D., Executive Vice President for Public Affairs, National Restaurant Association
5 Source IOM Sodium Report 2010
What’s the Problem?
� One third adults have hypertension; another third have
pre-hypertension
� Today’s 50 year olds have a 90% probability of developing high blood pressure
� The vast majority of medical community now agrees that the science now supports the link between excess sodium and hypertension
� Virtually every major national and international health agency that has reviewed the evidence has concluded that there are significant health risks associated with excess sodium consumption
6Source IOM Sodium report 2010
What’s the Problem?
� Sodium is safe and necessary, but only up to a point. In other words, sodium is not safe past a certain amount ... and Americans are regularly exceeding that amount
� Four decades of educating people about the dangers of too much salt and voluntary efforts by the food industry to cut salt have largely failed to dent Americans' excessive consumption
� Sodium is virtually ubiquitous in the U.S. food supply, present even in many things we don't think of as salty, such as sandwich bread and salad dressing
� Given how much sodium is added to our foods and meals before they reach our tables, we as individual consumers are not entirely in control of how much sodium we eat
Source IOM Sodium Report 2010
Sodium Reduction
� Why ?
© 2011 Institute of Food Technologists
Summary of Public Health Recommendations, Initiatives, and Actions
9
Source I0M Sodium Report 2010
Consumer Awareness Of The Relationship Between Salt/Sodium Intake And High Blood Pressure
10 SOURCES: 1979 and 1982: Heimbach, 1985; 1984–1994: Teisl et al., 1999; 2002: FDA, 2007.
0
10
20
30
40
50
60
Percent
1979
1982
19841986
1988
1990 1994
2002
Year
Consumer Sodium Research
Concern, Perceptions, and Action
August 2011
International Food Information Council 1100 Connecticut Avenue Washington, DC 20036www.foodinsight.org
18%26%
20% 21%12% 12%
20%13%
23%
29%
22%26%
22%16%
21%
19%
18%
19%
19%
20%
20%
13%
15%
14%
33%
22%
31%27%
34%
43%
35%
41%
9%4% 8% 6%
11%16%
8% 12% Extremely
concerned
Somewhat
concerned
Neither concerned
nor unconcerned
Not very
concerned
Not at all
concerned
OVERALL SODIUM CONCERN
How concerned are you with your personal sodium intake?Source IFIC 2011
12
A look at concern by age groups reveals that compared to 2009, more Americans age 25-34 say they are extremely concerned with their sodium intake while fewer individuals age 65-74 report such concern.
2011
Total 18-24 25-34 35-44 45-54 55-64 65-74 75+n=1005 n=137 n=184 n=196 n=200 n=154 n=90 n=42
09 09
70%
48%
47%
46%
45%
39%
38%
38%
32%
30%
27%
26%
23%
20%
19%
16%
13%
12%
11%
Increasing fruits and vegetables
Limiting sugar
Increasing fiber
Limiting saturated fat
Monitoring calories
Limiting trans fat
Limiting sodium
Limiting cholesterol
Increasing vitamins and minerals
Limiting carbohydrates
Increasing protein
Including lean meats
Limiting artificial ingredients
Increasing unsaturated fats
Limiting alcohol
Limiting artificial sweeteners
Including low-fat dairy
Limiting caffeine
Increasing calcium
CONTRIBUTORS TO A HEALTHY DIET
Q9. Which of the following factors are the three MOST important in contributing to a healthy diet? Source IFIC 2011
13
Limiting sodium continues to be third-tier among the factors contributing to a healthy diet.
While still convinced that increasing fruits and vegetables will contribute most to a healthy diet, Americans are also paying more attention to monitoring calories and limiting sugar and carbs.
n=1003Top 2 Boxes
2011
09
09
09
09
09
09
09
09
09
Tier I
Tier II
Tier III
Tier IV
PERCEPTIONS OF CONCERN AMONG POPULATION
Q19. Do you feel there are certain people who should be concerned with their sodium intake? Q20. [IF YES] What types of people should be concerned with their sodium intake?Source IFIC 2011
14
Although most Americans are not worried about their own consumption of sodium, they do think people with high blood pressure or weight issues should be concerned.
Yes83%
No4%
Don't know
13%
People with or concerned about high blood pressure
46%
People with weight issues 32%
People with or concerned about heart disease
14%
Everyone/all people 7%
People with or concerned about diabetes
7%
People who consume a lot of sodium 6%
People with health conditions or concerned about health (general)
5%
People who consume fried/fast foods 4%
Older people 4%
People who retain water 3%
n=1003
2011
09
n=837
No
74%
Yes
24%Don't know
2%
HIGH BLOOD PRESSURE TREATMENT
Q44. Are you currently being treated for high blood pressure?Source IFIC 2011
15
In 2011, close to 3 in 10 Americans are being treated for high blood pressure. 64% of those treated were also told to reduce their sodium intake.
No
74%
Yes
25%Don't know
2%
n=1005
Being treated for high blood pressure
n=1003
2009 2011
42%
24%32% 30%
50%
63%
49%
63%
4%
7%
6% 5%
4%
1%
1%
2%
18%
24%
26%22%
16%
14%
7%
13%11%
15%
10%
13%
13%
8%
10%
6%
24%29% 26%
31%
18%13%
33%
16%I do not need to limit
sodium
I am not interested in
limiting sodium
I am interested in
limiting sodium, but I
have not started yet
I have tried limiting
sodium in the past, but
I am not anymore
I am currently trying to
limit sodium
CURRENT ACTION TOWARD SODIUM
Q34. Which of the following best describes your approach to sodium consumption?Source IFIC 2011 16
More Americans age 25-34 report in 2011 that they are currently trying to limit sodium consumption while those age 65-74 are more likely to report that they do not need to limit sodium intake.
Total 18-24 25-34 35-44 45-54 55-64 65-74 75+n=1005 n=137 n=184 n=196 n=200 n=154 n=90 n=42
09
09
09
12%8%
14% 12% 10% 10% 15%2%
18%
10%
19%17% 17%
25% 17%
11%
32%
36%
36%
31%30%
30%
24%
27%
29%34%
24%
31%32%
23%
31%
43%
10% 11% 7% 10% 11% 11% 14% 16% Strongly agree
Somewhat agree
Neither disagree
nor agree
Somewhat
disagree
Strongly disagree
PACKAGE CLAIMS
17
Q33. To what extent do you agree or disagree with the following statements regarding sodium? Scale: 1=”strongly disagree,” 2=”somewhat disagree,” 3=”neither disagree nor agree,” 4=”somewhat agree,” 5=”strongly agree” Source IFIC 2011
Consumers age 18-24, 35-54 and 65+ are more likely to agree that advertising foods or beverages as being low in sodium is likely to make them think more positively about the product.“If a food or beverage is advertised as being low in sodium I think more positively of that product.”
Total 18-24 25-34 35-44 45-54 55-64 65-74 75+n=1005 n=137 n=184 n=196 n=200 n=154 n=90 n=42
09
Strongly disagree
9%
Somewhat disagree
21%
Neither disagree
nor agree31%
Somewhat agree
31%
Strongly agree
8%
Strongly disagree
12%
Somewhat disagree
18%
Neither disagree
nor agree32%
Somewhat agree
29%
Strongly agree
10%
LOW-SODIUM PRODUCTS
Q32. To what extent do you agree or disagree with the following statements regarding sodium? Scale: 1=”strongly disagree,” 2=”somewhat disagree,” 3=”neither disagree nor agree,” 4=”somewhat agree,” 5=”strongly agree” Source IFIC 201118
Nearly 4 in 10 Americans continue to believe that low sodium products do not taste as good. About one-third do not have an opinion.
“Low or reduced sodium products do not taste as good.”
In 2011, more likely to agree low-sodium products do not taste as good (top 2 boxes):• Those who are 35+• Those with some college vs.
High school/less than high school
• Those who are married• White race vs. Hispanic
In 2011, more likely to agree low-sodium products do not taste as good (top 2 boxes):• Those who are 35+• Those with some college vs.
High school/less than high school
• Those who are married• White race vs. Hispanic
n=1005 n=1003
2009 2011
46%
23%
22%
8%
1%
About 3,000 mg
About 2,300 mg
About 1,500 mg
About 1,000 mg
Don't know
OVERALL AWARENESS
Q21. As far as you know, how much sodium should an average, healthy individual consume in one day? Source IFIC 201119
Many Americans continue to be unaware of the daily sodium
recommendations for healthy individuals.
Nearly half of Americans don’t know the appropriate sodium amount, and of those who say they know, many underestimate the values.
n=1003
Americans who don’t know the appropriate amount of sodium include:• <$35K vs. $75K+• High school or less than high school• Those with children
Americans who guess an amount of 2,300 include:• $35K-$150K vs. <$35K• Those with graduate school• White race vs. Black
Americans who guess an amount of 1,500 include:• $75K+ vs. <$35K• Those with some college+ vs. Those with
less than high school or high school
Americans who don’t know the appropriate amount of sodium include:• <$35K vs. $75K+• High school or less than high school• Those with children
Americans who guess an amount of 2,300 include:• $35K-$150K vs. <$35K• Those with graduate school• White race vs. Black
Americans who guess an amount of 1,500 include:• $75K+ vs. <$35K• Those with some college+ vs. Those with
less than high school or high school
2011
PERSONAL CONSUMPTION AWARENESS
Q38. As far as you know, how much sodium do you personally consume in one day?Source IFIC 201120
Overall, awareness of personal sodium consumption remains low. Specifically, among those with high blood pressure or heart disease, awareness is even lower.
More than half of all Americans don’t know how much sodium they personally consume in one day.
57% 59% 61%
13% 11% 10%
20% 18% 18%
7% 9% 8%
2% 3% 3%
About 3,000 mg
About 2,300 mg
About 1,500 mg
About 1,000 mg
Don't know
Total High Blood Heartn=1003 Pressure Disease
n =290 n=74
2011
SOURCE: Briefel and Johnson (2004) for 1971-2000 data; NHANES for
2003-2006 data.
Sodium Intake Trends :1971-2006
21
Intake More Than 2x Adequate Intake (AI)
22 SOURCE: NHANES 2003-2006.
% Exceeding Tolerable Upper Intake Level (UL)
23SOURCE: NHANES 2003-2006.
Sodium Reduction
� Where ?
© 2011 Institute of Food Technologists
43%
12%
14%
14%
17%
25%
16%
14%
17%
28%
6%
27%
37%
20%
10%
45%
15%
14%
13%
13%
23%
18%
12%
18%
29%
6%
26%
38%
21%
9%
Packaged and prepared
foods
Naturally-occurring
sodium in foods
Salt added while eating
Salt added during
cooking
Restaurant foods
Most
Second Most
Least
PERCEPTIONS OF SOURCES OF SODIUM IN DIET
Q27. Where does MOST of the sodium in your diet come from?Q28. Where does the second MOST amount of sodium in your diet come from? Q29. And where does the LEAST amount of sodium in your diet come from?Source IFIC 2011
25
Consumers continue to believe most of the sodium in their diet comes from packaged and prepared foods. In 2011, restaurant foods are also increasingly perceived as a source of sodium.
n=1005 n=1003
2009
09
2011
72%
69%
57%
51%
47%
38%
LIMITING SODIUM
Q36/36A. [IF LIMITING/LIMITED SODIUM INTAKE] How do you/did you limit your sodium intake? Source IFIC 2011
26
Consumers are most likely to reduce the amount of sodium consumed by using less during or after food preparation.
n=461
Limiting the salt I use during food preparation
Limiting the salt I put on foods after they're prepared
Purchasing reduced or low-sodium products
Comparing labels of similar products and choosing lower sodium product
Avoiding specific types of foods or beverages
Reducing specific foods or beverages
2011
Approximate Sources of Sodium
© 2011 Institute of Food Technologists
Processed Foods 50%
FAFH 40%
Home Preparation 5%
Home Table 5%
Sodium Density Home vs Away
28
Source of Food mg/1000 cal
Home 1,422
Away (total) 1,825
Restaurants 1,925
Fast food/pizza restaurants 1,805
School 1,629
Other 1,466
SOURCE: NHANES 2003–2006.
52%
36%
32%
31%
18%
24%
8%
9%
7%
4%
4%
6%
5%
7%
55%
54%
50%
30%
29%
17%
7%
5%
4%
3%
3%
3%
2%
2%
Snacks like chips, crackers
Lunch meat/hot dogs
Canned soup
Condiments
Frozen meals
Pizza
Can/frozen fruits/ veggies
Beverages
Dry seeds/nuts/beans
Cakes/brownies/muffins
Candy
Ready-to-eat cereal
Grains/pasta/rice
Bread/rolls
SODIUM LEVELS IN SPECIFIC FOODS
Q25. Which individual foods have the highest amount of sodium per serving? Q26. Of the foods you typically eat, which of the following foods contribute the most sodium to your total diet? Source IFIC 2011
29
Consumers tend to believe that the foods with highest amount of sodium per serving also contribute the most sodium to their personal diet.
n=1003
Foods with highest amounts of sodium per serving
Foods contributing highest amounts of sodium in personal diet
2011
Sodium Contribution by Food Category
30 SOURCE: NHANES 2003-2006.
Top Contributors to Sodium Intake
31
Food Group Food Item
Percentage of
Sodium
Contributed in
Food Group*
Mixed dishes = 44% of total daily sodium Sandwiches (excluding burgers) 35.3
Pizza with meat 12.2
Hamburgers/cheeseburgers 8.5
Mexican entrees 6.9
Pasta dishes, Italian style 6.5
Sum 69.4
Meat, meat alternates = 15.5% of total Chicken 25.0
Cheese 15.3
Eggs 12.1
Bacon/sausage 10.6
Beef 7.7
Sum 70.7
Grains = 11.4% of total Bread 21.5
Cold cereal 18.5
Rice 10.9
Pancakes, waffles, French toast 9.6
Crackers 9.0
Sum 69.5
Vegetables = 9.3% of total Salad (greens) 30.0
Cooked potatoes, not fried 16.7
Cooked potatoes, fried 15.2
Cooked tomatoes 9.2
Cooked green beans 4.3
Sum 75.4
Source IOM report 2010
Sodium Reduction
�Who ?
© 2011 Institute of Food Technologists
RECOMMENDATION 1: The FDA should expeditiously
initiate a process to set mandatory national standards for the
sodium content of foods
� Modify the GRAS status of salt added to processed foods
� Extend application of the GRAS modification to
restaurant/foodservice operations menu items
Revisit the GRAS status of other sodium-containing compounds
33 Source IOM sodium report 2010
Evaluation with Adjustment through Rulemaking
34 Source IOM sodium Report 2010
Ste
p-d
ow
n 1
Ste
p-d
ow
n 2
Ste
p-d
ow
n 3
Ste
p-d
ow
n 4
Fin
al S
tep
-do
wn
Implementation (Time)
Final level as
established
by regulation
FirstStep-down
Evaluation(Adjustment)
Evaluation(Adjustment)
Etc.
Notice and commentRulemaking
Data Gathering, Research and Stakeholder Dialogue
Evaluation(Adjustment)
INTERIM STRATEGIES
RECOMMENDATION 2:
35 Source IOM Sodium Report 2010
� The food industry should voluntarily act to
reduce the sodium content of foods in advance
of the implementation of mandatory standards
UK “Voluntary” Salt Targets
2. BREAD Current 2010
Targets
Revised 2010
Targets
Targets for 2012
2.1 Bread and rolls 1.1 g salt or 430 mg
sodium (average)
1.0 g salt or 400 mg
sodium (average)
2.2 Bread and rolls
with additions
1.3 g salt or 500 mg
sodium (average)
1.2 g salt or 480 mg
sodium (average)
2.3 Morning goods 1.3 g salt or 500 mg
sodium (average)
1.3 g salt or 500 mg
sodium (average)
1.0 g salt or 400 mg
sodium (maximum)
Source FSA (UK) Web Site
National Salt Reduction Initiative
37 Source NSRI Press release
� MAYOR BLOOMBERG, DEPUTY MAYOR GIBBS AND HEALTH COMMISSIONER FARLEY ANNOUNCE FIRST COMPANIES TO COMMIT TO NATIONAL SALT REDUCTION INITIATIVE
� NYC-led National Initiative Establishes Framework to Reduce Sodium by 25% in Packaged and Restaurant Foods by 2014
� Voluntary Initiative Could Prevent Tens of Thousands of Needless Deaths from Heart Attack and Stroke
� The National Salt Reduction Initiative partnership now includes :
-18 national health organizations;
- 29 cities, states and related entities;
- Some of the nation’s leading food companies, including: Au Bon Pain, Boar’s Head, FreshDirect, Goya, Hain Celestial, Heinz, Kraft, LiDestri, Mars Food, McCain Foods, Red Gold, Starbucks, Subway, Unilever, Uno Chicago Grill and White Rose.
NSRI : Kraft Commitments
38 Source NSRI Press release
� Bacon (2012)
� Plan to meet or exceed the 2012 sodium reduction targets in 50% of the relevant NSRI categories, which represents the large majority of the foods that we sell.
� • Working toward a 10% average sodium reduction across our North American food portfolio
SUPPORTING STRATEGIES
39 Source IOM Sodium Report 2010
� Strategy 3.1 FDA and the U.S. Department of Agriculture (USDA) should revise and update—specifically for sodium—the provisions for nutrition labeling, related sodium claims, and disclosure/disqualifying criteria for sodium in foods, including a revision to base the Daily Value (DV) for sodium on the Adequate Intake (AI)
� Strategy 3.3 Congress should act to remove the exemption from nutrition labeling for food products intended solely for use in restaurant/foodservice operations
� Strategy 3.4 Food retailers, governments, businesses, institutions, and other large-scale organizations that purchase or distribute food should establish sodium specifications for the foods they purchase and the food operations they oversee
Sodium Reduction
�When ?
© 2011 Institute of Food Technologists
Stepwise Modification to GRAS
41 Source IOM Sodium Report 2010
0 50 60 70 80 100
Salt Level (mg/serving)
Not GRAS
GRAS
Stepwise Modification to GRAS with Disclosure
42 Source IOM Sodium Report 2010
0 50 60 70 80 100
Salt Level (mg/serving)
Not GRAS
GRAS with Labeling
GRAS
0 50 60 70 80 100
Salt Level (mg/serving)
Not GRAS
GRAS with Labeling
GRAS
5% 4% 4% 6% 2% 6% 8% 2%
10% 9% 11% 10%11%
8% 8%12%
26% 31% 31% 28%24% 18% 19% 26%
36%
39% 34%32%
36% 39% 34%
43%
24%17% 20% 24% 28% 28% 31%
16% Strongly agree
Somewhat agree
Neither disagree
nor agree
Somewhat
disagree
Strongly disagree
REDUCING SALT IN DIET
Q31. To what extent do you agree or disagree with the following statements regarding sodium? Scale: 1=”strongly disagree,” 2=”somewhat disagree,” 3=”neither disagree nor agree,” 4=”somewhat agree,” 5=”strongly agree” Source IFIC 201143
Compared to 2009, more consumers age 45-54 strongly agree with this statement in 2011.
“If you cut down on the amount of salt you eat your preference for the taste of salt will change.”
Total 18-24 25-34 35-44 45-54 55-64 65-74 75+n=1005 n=137 n=184 n=196 n=200 n=154 n=90 n=42
09
Sodium Reduction
�How ?
© 2011 Institute of Food Technologists
73%
72%
65%
61%
62%
73%
70%
66%
63%
60%
2009 2011
SUCCESS IMPLEMENTING JNC-7 FACTORS
Q13-17. How successful would you be personally in achieving the following?Scale: 1=”not successful at all,” 2=”somewhat unsuccessful,” 3=”neither successful nor unsuccessful,” 4=”somewhat successful,” 5=”extremely successful,” 6=“Not applicable”Source IFIC 2011
45
More consumers believe they would be likely to succeed in moderating their alcohol consumption and eating a balanced diet than in reducing the sodium they consume or losing weight.
Top 2 Boxes (somewhat/extremely successful) N/A
Moderate alcohol consumption
Eating a balanced diet rich in fruits and vegetables, whole
grains, and low-fat dairy foods
Being physically active regularly
Reducing my weight if I am overweight
Reducing my Sodium
27%
23%
1%
2%
1%
2%
4%
4%
12%
11%
Correlation Values for Sodium-to-Calorie Intake
46 Source IOM Sodium Report 2010
Change in portion sizes 1977-1996
47
SOURCE: Nielsen and Popkin, 2003. Journal of the American Medical Association 289(4), p.450-453.
Copyright©2003 American Medical Association. All rights reserved.
0
1
2
3
4
5
6
7
8
9
Salty Snacks French Fries Cheeseburgers Pizza Mexican Food
1977-1978
1989-1991
1994-1996
Ou
nce
s
Trends in Sodium Density:1971-2006
48
Differences in Sodium Content of Similar Foods
49
SOURCE: CSPI, 2008. “Salt Assault: Brand-name Comparisons of Processed Foods.” Reprinted with permission.
Sodium / Potassium Ratio
© 2011 Institute of Food Technologists
A.I.mg/day
Intakemg/day
RatioIntake/A.I.
Na 1500 3500 2.7
K 4700 2400 0.5
Na/K
Ratio
0.3 1.5
Sodium Reduction Summary
© 2011 Institute of Food Technologists
Why ? Consumers cant control their intake
Who ? Food processors and FAFH operators
Where ? Highest contributors to diet
When ? Now ! And in steps for next 10+ years
How ? Portion Size,Replace Na with K,
Compare across category and countries
© 2011 Institute of Food Technologists
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