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 Survey

Authors: COGSWELL, MARY - Centers For Disease Control And Prevention (CDC) - United States; PATEL, SM SHEENA - Centers For Disease Control And Prevention (CDC) - United States; YUAN, KEMING - Centers For Disease Control And Prevention (CDC) - United States; GILLESPIE, CATHLEEN - Centers For Disease Control And Prevention (CDC) - United States; JUAN, WEN YEN - Food And Drug Administration(FDA); CURTIS, CHRISTINE - Nyc Department Of Health And Mental Hygiene; VIGNEAULT, MICHEL - Health Canada; CLAPP, JENIFER - Nyc Department Of Health And Mental Hygiene; ROACH, PAULA - Health Canada; MOSHFEGH, ALANNA - US Department Of Agriculture (USDA); Ahuja, Jaspreet; Pehrsson, Pamela; BROOKMIRE, LAUREN - Food And Drug Administration(FDA); MERRITT, ROBERT - Centers For Disease Control And Prevention (CDC) - United States

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/8/2017
Publication Date: 7/12/2017
Citation: Cogswell, M.E., Patel, S.M., Yuan, K., Gillespie, C., Juan, W., Curtis, C.J., Vigneault, M., Clapp, J., Roach, P., Moshfegh, A., Ahuja, J.K., Pehrsson, P.R., Brookmire, L., Merritt, R. 2017. 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: NHANES. American Journal of Clinical Nutrition. doi:10.3945/ajcn.116.145623.

Interpretive Summary: About 2 in 3 U.S. adults have pre-hypertension or hypertension increasing their risk of cardiovascular disease. Reducing sodium intake can decrease blood pressure and prevent hypertension. About 9 in 10 Americans consume excess sodium, >2300 mg daily. Most (>70%) of our sodium intake comes from processed and restaurant foods, rather than salt added at the table or during home preparation/cooking. Reformulating food products to contain less salt and other sodium compounds is promoted as an effective and feasible public health strategy that affects the majority of the population without requiring specific behavioral changes. Recently, the U.S. Food and Drug Administration published “Draft Guidance for Industry: Voluntary Sodium Reduction Goals: Target Mean and Upper Bound Concentrations for Sodium in Commercially Processed, Packaged, and Prepared Foods.” The FDA targets and upper bounds were informed by and build on voluntary standards for the sodium content of commercially-processed and prepared foods already introduced in North America by New York City’s National Sodium Reduction Initiative (NSRI) and Health Canada standards. The impact of these existing voluntary standards (targets, upper bounds, and benchmarks) on sodium intake overall and by population subgroups is unknown. Using dietary intake data for 17,933 participants aged > 1 year from What We Eat In America, National Health and Nutrition Examination Survey (WWEIA, NHANES) 2007-2008 and 2009-2010, the authors found that across age, sex, and race-ethnic population subgroups, the average predicted relative reductions in sodium intake were 19%-20% using NSRI targets and 16%-19% using Health Canada’s benchmarks. The proportion of adults aged 19 years and older consuming >2300 mg daily would decline from 88% (95% CI, 86%, 91%) to 71% (95% CI, 68%, 73%) using NSRI targets and to 74% (95% CI, 71%, 76%) using Health Canada benchmarks. The results suggest if commercially-processed and prepared foods meet established sodium standards, a significant reduction of sodium intake could occur in U.S. However, even with these significant reductions, average sodium intake for the U.S. population aged one year and older, and all subgroups of adults, would remain above Healthy People 2020 objective of 2300 mg/d. These results will help guide public health policy on sodium reduction in the U.S.

Technical Abstract: About 2 in 3 U.S. adults have pre-hypertension or hypertension increasing their risk of cardiovascular disease. Reducing sodium intake can decrease blood pressure and prevent hypertension. About 9 in 10 Americans consume excess sodium, >2300 mg daily. Voluntary sodium reduction standards for commercially-processed and prepared foods have been established to encourage industry to reduce sodium concentrations in foods, thereby reducing intake. The authors hypothesize that meeting New York City’s (NYC) National Sodium Reduction Initiative (NSRI) and Health Canada standards for commercially-processed and prepared food standards would reduce U.S. sodium intake. We used data for 17,933 participants aged > 1 year from What We Eat In America, National Health and Nutrition Examination Survey (WWEIA, NHANES) 2007-2008 and 2009-2010 to model predicted U.S. daily average sodium intake and the prevalence of excess sodium intake using the above standards. FNDDS (Food and Nutrient Database for Dietary Studies) food codes corresponding to foods reported by WWEIA, NHANES participants were matched to NSRI and Health Canada food categories and the published sales weighted averaged percent reductions were applied. If NSRI 2014 targets were met, we estimated the U.S. population aged >1 year could have reduced their average usual daily mean sodium intake of 3417 mg by 698 mg (95% CI, 683-714 mg) and if Health Canada’s 2016 benchmarks were met, by 615 mg (95% CI, 597-634 mg). Across age, sex, and race-ethnic population subgroups, the average predicted relative reductions in sodium intake were 19%-20% using NSRI targets and 16%-19% using Health Canada’s benchmarks. The proportion of adults aged 19 years and older consuming >2300 mg daily would decline from 88% (95% CI, 86%, 91%) to 71% (95% CI, 68%, 73%) using NSRI targets and to 74% (95% CI, 71%, 76%) using Health Canada benchmarks. Results suggest if commercially-processed and prepared foods meet established sodium standards, a significant reduction of sodium intake could occur in U.S.