Sodium Overview CDC Heart Disease and Stroke Prevention 2010 Grantee Meeting Janelle Peralez Gunn Division for Heart Disease and Stroke Prevention Centers.

Sodium Overview

CDC Heart Disease and Stroke Prevention2010 Grantee Meeting

Janelle Peralez GunnDivision for Heart Disease and Stroke Prevention

Centers for Disease Control and Prevention

September 15, 2010

Presentation Overview

• Brief Overview – Sodium a public health imperative

• Current Action – US and globally

• Scope of Opportunity

Sodium Chloride is the chemical name for salt

• 90% of the sodium we consume is in the form of salt

• Other food additives contain sodium

• Some amount of sodium is naturally occurring in foods

Is it Salt or Sodium?

Sodium Reduction: A Public Health Imperative

• High blood pressure is a primary risk factor for heart disease and stroke, the first and third leading causes of death in the United States.

• Sodium reduction can have a significant impact on reducing disparities and cardiovascular disease events.

• Sodium reduction is a population-based strategy to help reduce the prevalence of high blood pressure and improve control.

Salt and High Blood Pressure• Increased sodium in the diet → increased blood pressure →

increased risk for heart attack and stroke.

• A population shift in SBP of 12-13 points could reduce:

• heart attacks by 21%

• strokes by 37%

• total CVD deaths 25%• Even people with blood pressure in the optimal range benefit

from sodium reduction and reduced risk for heart attack and stroke.

Estimated effects on prevalence of hypertension and its related costs if sodium intake was reduced in U.S. Adults

• Reducing average population intake to 2300 mg per day (current recommended maximum) may…

• reduce cases of hypertension by 11 million• save $18 billion health care dollars• gain 312,000 Quality Adjusted Life Years (QALYs)

• Even fewer cases of hypertension and more dollars saved if intake was reduced to 1500 mg per day (recommended maximum level for “specific population”)

American Journal of Health Promotion. 2009;24:49-57.

A few are meeting the target daily intake:

ScopeMet the 2005 DGA Recommendation

All Adults 9.6%

<2,300 mg/day Recommended 18.8%

≤1,500 mg/day Recommended 5.5%

With hypertension 5.9%

Aged 40 years and older without hypertension

5.1%

Black, aged 20–39 years 5.7%

• Source: Source: Centers for Disease Control and Prevention. Sodium Intake Among Adults --- United States, 2005−2006. MMWR. 2010; 59(24);746-749.

Sources of Dietary SodiumRank Food Group

1 Yeast breads

2 Chicken and chicken mixed dishes

3 Pizza

4 Pasta and pasta dishes

5 Cold cuts

6 Condiments

7 Mexican mixed dishes

8 Sausage, franks, bacon, and ribs

9 Regular cheese

10 Grain-based desserts

• Source: Sources of Sodium Among the US Population, 2005-06. Risk Factor Monitoring and Methods Branch Website. Applied Research Program. National Cancer Institute.

IOM Strategies to Reduce Sodium Intake

In 2008, CDC received congressional language to support an IOM study

Other sponsors: FDA, ODPHP, NHLBIStudy would examine and make

recommendations about various means to reduce dietary sodium intake

Start date : October 2008Report released on April 2010

IOM Recommendations Primary Strategy

FDA should expeditiously initiate a process to set mandatory national standards for the sodium content of foods

• Applies to processed and restaurant foods• Utilize generally recognized as safe (GRAS) status of salt

Interim Strategy Food industry should voluntarily act to reduce the sodium content

of foods in advance of the implementation of mandatory standards

IOM Strategies to Reduce Sodium Intake

Supporting Strategies Government agencies, public health organizations, consumer

organizations, and food industry should carry out activities to support the reduction of sodium in food supply

• Revise daily value for sodium• Re-evaluate sodium claims/disclosures on foods• Label foods sold to restaurants• Food procurement standards• Innovative restaurant initiatives

IOM Strategies to Reduce Sodium Intake

IOM Recommendations

IOM Recommendations Supporting Strategies Continued

Government agencies, public health organizations, consumer organizations, health professionals, the health insurance industry, food industry, and public-private partnerships should conduct augmenting activities to support consumers in reducing sodium intake

• HHS create nationwide campaign to reduce sodium intake• Continuation and expansion of existing efforts

Federal agencies should ensure and enhance monitoring and surveillance relative to sodium intake measurement, salt taste preference, and sodium content of foods, and should ensure sustained and timely release of data in user-friendly formats

IOM Strategies to Reduce Sodium Intake

National• CDC

– Convenes experts in science, policy, evaluation, communications, and program implementation.

– Works with other federal agencies to enhance and expand sodium related surveillance

– Expands knowledge/contribute to science base of sodium and health

– Supports state and local initiatives– Educate the public– Work with industry

National• FDA

– GRAS status of sodium– Nutrition Facts Panel – Front of Package Labeling– Developing menu labeling regulations

• USDA/ First Lady’s Initiative Lets Move– Environmental Food Atlas– Healthier US Schools Challenge

National• Strong National Support

– Organizational sodium reduction policies– Support for the NSRI– Several industry groups have made significant public

announcements

State and Local Activity

• ARRA Funded Communities

• Salt Reduction Task Force

• Menu labeling/ labeling

• School foods projects

Global Sodium Reduction• Not just a public health issue for the United States.

– HBP is the primary contributor globally to heart disease and stroke.

• Reformulation of products has occurred in other countries.– Sodium content of identical products in other

countries can be significantly lower.

CDC Participation in Global Activities • WHO:

– CDC participated in the WHO forum and technical meeting on sodium and the follow-up meeting on iodine

• PAHO:– Partners Forum– PAHO Expert Group on Sodium Reduction in the Americas

• China:– Collaboration with China CDC, George Institute (Beijing and Sydney) and NHLBI

on a sodium reduction/ hypertension prevention and control initiative

Why Action is Needed at State and Local Levels

• Strong scientific evidence supports the need for population-wide sodium reduction due to the harmful impact of sodium on blood pressure.

• Individual behavior change is difficult.

• The most effective population approach to reducing sodium intake is to reduce the sodium content of restaurant and processed foods, which contribute the vast majority of sodium in the food supply.

• All current approaches are voluntary.

Scope of Opportunity

Healthier Food Environment = Healthier Population

• Changing the food environment gives consumers a broader range of healthful foods from which to choose.

• Policy and environmental strategies are effective at the state and local level

Potential Scope: State and LocalProcurement Policies• State and local governments can be large purchasers• Can impact a variety of settings • Model healthier eating• Potentially drive reformulation

Menu Labeling • Inform consumers regarding sodium content• May drive some product reformulation • More useful with a reference point

Innovative Restaurant and Grocery Store Initiatives

potential range of strategies is for informational purposes only

Potential Scope: State and LocalHealth Communications Campaign• Can be supported by policy and vice versa • Can take many forms • Tools can aid consumers

Venue Based Policy• Considers all possibilities for a particular venue

potential range of strategies is for informational purposes only

Potential Scope: State and LocalTax incentives or Credits• Tax credits could be supplied based on volume of lower-

sodium foods sold• May not result in broad reduction in sodium intake across the

population

Salt Tax• Would be inelastic and may not impact purchasing • Would also tax foods that may be otherwise nutritious

potential range of strategies is for informational purposes only

Potential Scope: State and LocalCap and Trade• Traditionally been applied for reducing air pollutants• May not result in broad reduction in sodium intake across the

population

Performance-based Regulation • Required to meet government-established targets• Retailers have flexibility to adapt

potential range of strategies is for informational purposes only

For More Information

Janelle Peralez [email protected]

Nicole [email protected]

The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the CDC.