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Strategies to Reduce Sodium Intake in the United
States
Jane E. Henney, Christine L. Taylor, and Caitlin S.
Boon, Editors; Committee on Strategies to Reduce
Sodium Intake; Institute of Medicine
ISBN: 0-309-14806-5, 480 pages, 6 x 9, (2010)
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Strategies to Reduce Sodium Intake in the United States
http://www.nap.edu/catalog/12818.html
Strategies to Reduce
Sodium Intake in the United
States
Committee on Strategies to Reduce Sodium Intake
Food and Nutrition Board
Jane E. Henney, Christine L. Taylor, and Caitlin S. Boon,
Editors
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Copyright © National Academy of Sciences. All rights reserved.
Strategies to Reduce Sodium Intake in the United States
http://www.nap.edu/catalog/12818.html
THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, N.W. • Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the
Governing Board of the National Research Council, whose members are drawn
from the councils of the National Academy of Sciences, the National Academy
of Engineering, and the Institute of Medicine.
This study was supported by Contract No. 200-2005-13434, Task Order No. 14,
between the National Academy of Sciences and Centers for Disease Control and
Prevention; Contract No. N01-OD-4-2139, Task Order No. 219, between the
National Academy of Sciences and the National Institutes of Health, National
Heart, Lung, and Blood Institute; Contract No. HHSF223200811156P between
the National Academy of Sciences and the Food and Drug Administration; and
Contract No. HHSP233200800635P between the National Academy of Sciences
and Office of Disease Prevention and Health Promotion. Any opinions, findings,
conclusions, or recommendations expressed in this publication are those of the
author(s) and do not necessarily reflect the view of the organizations or agencies
that provided support for this project.
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Copyright 2010 by the National Academy of Sciences. All rights reserved.
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Suggested citation: IOM (Institute of Medicine). 2010. Strategies to Reduce
Sodium Intake in the United States. Washington, DC: The National Academies
Press.
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PREPUBLICATION COPY: UNCORRECTED PROOFS
Copyright © National Academy of Sciences. All rights reserved.
Strategies to Reduce Sodium Intake in the United States
http://www.nap.edu/catalog/12818.html
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of
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Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the
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The National Academy of Engineering also sponsors engineering programs aimed at
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Strategies to Reduce Sodium Intake in the United States
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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, MD
Study Staff
CHRISTINE L. TAYLOR, Study Director
CAITLIN S. BOON, Program Officer
HEATHER B. DEL VALLE, Associate Program Officer
EMILY ANN MILLER, Research Associate
MARIANNE J. DATILES, Senior Program Assistant (from December
2007 to June 2009)
SAUNDRA LEE, Senior Program Assistant (from June 2009)
ANTON BANDY, Financial Officer
GERALDINE KENNEDO, Administrative Assistant
LINDA D. MEYERS, Director, Food and Nutrition Board
v
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Strategies to Reduce Sodium Intake in the United States
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Copyright © National Academy of Sciences. All rights reserved.
Strategies to Reduce Sodium Intake in the United States
http://www.nap.edu/catalog/12818.html
Reviewers
This report has been reviewed in draft form by individuals chosen for
their diverse perspectives and technical expertise, in accordance with
procedures approved by the National Research Council’s Report Review
Committee. The purpose of this independent review is to provide candid
and critical comments that will assist the institution in making its
published report as sound as possible and to ensure that the report meets
institutional standards for objectivity, evidence, and responsiveness to
the study charge. The review comments and draft manuscript remain
confidential to protect the integrity of the deliberative process. We wish
to thank the following individuals for their review of this report:
Armand V. Cardello, U.S. Army Natick Soldier R,D&E Center, Natick,
MA
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 Hill
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, MA
Although the reviewers listed above have provided many
constructive comments and suggestions, they were not asked to endorse
vii
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Strategies to Reduce Sodium Intake in the United States
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.
the final draft of the report before its release. The review of this report
was overseen by Elaine L. Larson, Columbia University, and Johanna
Dwyer, National Institutes of Health. Appointed by the Institute of
Medicine, they were responsible for making certain that an independent
examination of this report was carried out in accordance with
institutional procedures and that all review comments were carefully
considered. Responsibility for the final content of this report rests
entirely with the authors and the institution.
viii
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Preface
In 1969, the White House Conference on Food, Nutrition, and Health
issued recommendations that, among other important nutrition concerns,
highlighted the role of sodium in hypertension and marked the starting
point of public health initiatives to address the high levels of sodium
intake among the U.S. population. Forty years later, in January 2009, the
first meeting of the Institute of Medicine (IOM) Committee on Strategies
to Reduce Sodium Intake convened. In the intervening years, much had
changed—what we eat, where we eat, and who prepares our food.
However, in spite of the attempts of many in both the public health
community and the food industry, what did not change is the amount of
sodium we consume each day, largely in the form of salt. High sodium
intake puts the whole population—young and old, male and female, all
ethnic groups—at risk for hypertension and subsequent cardiovascular
events such as heart failure and stroke.
Hypertension is extraordinarily common: 32 percent of adult
Americans have hypertension, and roughly another third have pre-
hypertension. The costs of these health conditions are
staggering. Estimates place the direct and indirect costs of hypertension
at $73.4 billion in 2009.
The committee’s charge was to recommend strategies to reduce
Americans’ intake of sodium to levels consistent with the Dietary
Guidelines for Americans. In the wake of the many unsuccessful and/or
unsustainable efforts, this was no small task, but—in light of the
potential public health benefit that could be achieved if the goal was
met—it was a worthy one. Simply put, the task of the committee was
broad, far-reaching, and complex. I am delighted that the assembled
committee had the individual expertise and experience as well as the
collective will to serve the health of the public and the willingness to
meet the significant challenge of our charge. It was a privilege to be a
part of this effort.
Over the course of the study, we met often and consulted many
sources. Our first meeting set the tone as we heard from each of our
study sponsors. A subsequent public hearing elicited needed input and
was extremely useful to the committee’s deliberations. Invited speakers
ix
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