1. National Salt Reduction Initiative
- Elizabeth Leonard, MPH, Project Coordinator, New York City Department of Health and Mental Hygiene
Plenary VI Sodium: Actions and Insights from National Forum Members and Stakeholders

2. Insights from the National Salt Reduction Initiative
Elizabeth Leonard
Nutrition Strategy Program
Bureau of Chronic Disease Prevention and Tobacco Control
New York City Department of Health and Mental Hygiene
October 9, 2013

3. NSRI Overview
Decrease sodium content in foods by 25% over 5 years
Decrease population sodium intake by 20% over 5 years
Reduce risk of heart attack and stroke – the leading cause of death in US
Partnership of 95+ city and state health authorities and national health organizations
Voluntary sodium targets following 100+ meetings with industry
Almost 30 companies committed to NSRI targets

4. National Salt Reduction Initiative
Deaths Attributable to Total Effects of Individual Risk Factors
-50,000
450,000
250,000
350,000
50,000
150,000
Source: Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, et al. (2009) The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors. PLoS Med 6(4). b. Effect of high dietary salt on cardiovascular diseases was estimated through its measured effects of systolic bp.c. Protective effects of alcohol use on cardiovascular diseases are its net effects. Regular moderate alcohol use is protective for IHD, ischemic stroke, and diabetes but any use is hazardous for hypertensive disease, hemorrhagic stroke, cardiac arrhythmias, and other cardiovascular diseases.

5. Most Salt Intake Comes from Processed and restaurant foods
Processed Foods
Processed and restaurant foods
77%
12%
While eating 6% 5%
Mattes, RD. Donnelly D. Relative Contributions of Dietary Sodium Sources. Journal of American College Nutrition, 1991, 10: 5

6. International Attention to Salt
Finland
Requires high salt warnings for products that exceed a category-specific level, beginning in the 1990s
United Kingdom
Coordinated voluntary national effort with sodium targets across 80 food categories for 2008 and 2010
50+ commitments from all sectors of industry, future planning underway
Australia
Food and Health Dialogue is currently releasing targets by category, on a rolling basis
Pan American Health Organization / World Health Organization
Established an Expert Group that developed recommendations to reduce population-wide dietary salt intake

7. US Context
Institute of Medicine published report on Strategies to Reduce Sodium Intake in 2010:
Primary recommendation: mandatory limits on sodium
Interim recommendation: coordinated voluntary approach

8. NSRI Partners Across U.S.
State Health Department
State Health Association
City or County Health
Department
State & City Health Departments
Health Organizations
Academy of Nutrition and Dietetics (ADA)
American College of Cardiology
American College of Epidemiology
American Heart Association
American Medical Association
American Public Health Association
American Society of Hypertension
Association of Black Cardiologists
Consumers Union
Health Power for Minorities (Health Power)
InterAmerican Heart Foundation
International Society on Hypertension in Blacks
Kaiser Permanente
National Forum for Heart Disease and Stroke Prevention
National Hispanic Medical Association
National Kidney Foundation
Partnership for Prevention
Preventive Cardiovascular Nurses Association
Public Health Law Center at William Mitchell College of Law
Society for the Analysis of African-American Public Health Issues
World Hypertension League
State & Local Associations
Association of State and Territorial Health Officials
Association of State and Territorial Public Health Nutrition Directors
California Conference of Local Health Officers
Council of State and Territorial Epidemiologists
Mississippi Task Force on Heart Disease and Stroke Prevention
Missouri Activity for Activity and Nutrition
National Association of Chronic Disease Directors
National Association of County and City Health Officials
New York State Chapter, American College of Cardiology
Northern Illinois Public Health Consortium
Northwest Kidney Centers
South Carolina Institute of Medicine & Public Health
Texas Association of Local Health Officials
Texas Medical Association
Texas Salt Reduction Collaborative
Wisconsin Heart Disease and Stroke Alliance

9. Determining Baseline Sodium Levels
Built Databases: Contains nutrition and sales data for thousands of packaged and restaurant foods
Analyze Databases: Collecting this data exposed the variation of sodium across similar products
Whole Wheat Bread
480mg sodium
Whole Grain Bread
160mg sodium
3X amount of sodium

10. NSRI Strategy
Set Targets: Sodium targets set for 2012 and for each of the 62 packaged food and 25 restaurant food categories
Invite Commitments: 28 food companies are committed to the NSRI
Monitor changes: Analyze changes in sodium in foods over time

11. Category Sodium Distributionmg mg
Mean 530 mg

12. 21 Companies Met 2012 NSRI Targets
Packaged Food
Butterball
Furmano Foods
Goya Foods
Heinz
Ken’s Foods
Kraft Foods
LiDestri Foods/ Francesco Rinaldi
Mars Food
McCain Foods
Mondelēz International
Red Gold
Snyder’s-Lance
Unilever
White Rose
Restaurant Food
Au Bon Pain
Starbucks
Subway
Uno Chicago Grill
Food Retailers
Delhaize America
FreshDirect
Target Corporation

13. How We Assess Progress
Track changes in sodium content of packaged and restaurant food in 2012 and 2014 using:
Packaged and Restaurant Food Databases
Industry-reported data
Implement baseline and follow up 24-hour urinary evaluation

14. Next Steps for the NSRI
Track changes in sodium content of packaged and restaurant food
Invite companies to commit to 2014 targets
Expand NSRI partnership through continued collaboration with national health organizations, cities, and states and continued coordination with federal agencies

15. Thank You Elizabeth Leonard eleonard1@health.nyc.gov