Chicago Section IFT Technical Session Salt Reduction & its .../media/Knowledge Center/Focus Areas/Food Health and... · SONIA Y. ANGELL, New York City Department of Health and Mental

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 ?


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


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 ?


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


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 ?


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)


Etc.

Notice and commentRulemaking

Data Gathering, Research and Stakeholder Dialogue


INTERIM STRATEGIES

RECOMMENDATION 2:


� 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


sodium (average)


sodium (average)

2.3 Morning goods 1.3 g salt or 500 mg

sodium (average)


sodium (average)


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


� 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 ?


Stepwise Modification to GRAS


0 50 60 70 80 100

Salt Level (mg/serving)

Not GRAS

GRAS

Stepwise Modification to GRAS with Disclosure


0 50 60 70 80 100


Not GRAS

GRAS with Labeling

GRAS

0 50 60 70 80 100


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


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 ?


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


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


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


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


Headquarters

525 W. Van Buren Street

Suite 1000

Chicago, IL 60607

+1.312.782.8424

ift.org

Washington, D.C. Office

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+1.202.466.5980

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Institute of Food Technologists

Documents

Chicago Section IFT Technical Session Salt Reduction & its .../media/Knowledge Center/Focus Areas/Food Health and... · SONIA Y. ANGELL, New York City Department of Health and Mental