Strategies to Reduce Sodium Intake in the United States (2010) / Chapter Skim
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10 Next Steps
10 Next Steps
Pages 297-316
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From page 297... ...
This final chapter discusses the next steps for strategies to reduce sodium intake, first in terms of options and approaches for implementation of the strategies and then in terms of research needs. The approaches highlighted below were developed following the committee's recommendations and with the understanding that implementers will -- as a first step and as an ongoing activity -- need to carry out data gathering and targeted research to ensure appropriate implementation of the strategies.
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From page 298... ...
Rather, the nature of the food supply suggests that the better approach is to develop standards for the levels of salt added to foods on the basis of food categories. In the United Kingdom, salt targets were set for all product categories, based on the contributions of different foods to salt intake and the feasibility of making reductions given food safety and technical considerations.1 If foods are grouped by category, the technological feasibility of reducing salt levels can be taken into account along with consumers' taste expectations.
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From page 299... ...
This maximum level of salt -- shown in the figure as 50 mg and labeled "Maximum Level for GRAS Status" -- would allow persons to consume such a food from this category in typical fashion as part of a normal diet and yet keep their total daily intake of sodium at recommended levels given all other foods commonly consumed (each with its own category standards for salt content)
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From page 300... ...
FIGURE 10-1 Modification of the GRAS status of salt for a hypothetical food category. Panel A: Final Maximum Level: Regulatory specification of salt content per serving for a hypothetical food category with a range of 0–100 mg of salt per serving.
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From page 301... ...
Although cautious in its approach, the committee concluded that it may be possible to stimulate food manufacturers to work more quickly toward the appropriate maximum GRAS level if special labeling/disclosure statements were incorporated as part of the specified gradual implementation process. Additionally, the location of the special label/disclosure statement is an important factor.
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From page 302... ...
FIGURE 10-2 Example of hypothetical use of special labeling/disclosure statements as part of the stepwise implementation process. Panel A: At the time of the first stepwise reduction in the year 2015, foods with amounts per serving between the 2015 target and the target for 2018 (i.e., between 70 and 80 mg)
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From page 303... ...
It has not been possible to define the nature of such exemptions as part of the committee's work, but it was anticipated that FDA's in-depth analysis of the food supply, information-gathering efforts, and related consumer behavior may reveal the desirability of such exemptions. While the use of such labeling on products may not appeal to food manufacturers and thus may motivate them to seek further alternatives to lower the sodium content of their products, it was recognized that, consistent with Section 409 of the Federal Food, Drug, and Cosmetic Act, this would have to be based on appropriate research to demonstrate the ability of the labeling to protect public health.
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From page 304... ...
. There are unique challenges to reducing sodium in restaurant/foodservice operations, and as described previously, past initiatives to reduce sodium intake have focused relatively little attention on these operations compared to processed foods.
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From page 305... ...
Summary The committee believes that the modification of the GRAS status of salt in processed food could be accomplished best if FDA: • specifies as GRAS the uses and use levels for salt that allow persons to consume such foods as part of a normal diet with a reasonable likelihood of keeping their total daily intake of sodium consistent with the Dietary Guidelines for Americans -- these foods could be sold freely; • implements special labeling/disclosure statements, or informational labeling on foods as part of a stepwise implementation process for modification of the GRAS status of salt, provided research demon strates that the labeling is effective -- such labeling may (1) stimu late efforts on the part of the food industry to implement changes in sodium content more quickly, and/or (2)
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From page 306... ...
Activities important to FDA's successful management of this process include: • implementation of changes in GRAS uses and use levels in a step wise fashion so as to allow the food industry as well as the con sumer to adjust to reduced sodium content in foods, and as to take into account research on conditions conducive to lowering salt taste preferences; • establishment of standards by food category, taking into account the relative dietary contribution of the food category, functional and safety issues, and as appropriate, the lessons learned from oth ers who have developed standards for sodium in foods on the basis of food categories; • incorporation of a decision-making process fully informed by in depth analysis of the food supply and the uses or functions of salt coupled with simulation modeling of the effects of different levels of sodium content on total intake, examination of consumer eating behaviors, consideration of food safety, and studies of economic impact and potential unintended consequences; • sensitivity to burdens on small business; • in the case of non-GRAS uses and use levels, timely and responsive management of the available petition process; and
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From page 307... ...
reducing the sodium content of the food supply, (2) lowering preferences for salty foods, and (3)
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From page 308... ...
In the case of large restaurants and chains, formulation decisions about the salt content of menu items may be centralized and standardized, although implementation may be widely dispersed among a diversity of staff. In the case of small independent restaurants, decisions regarding sodium content are often not standardized or centralized and may vary even daily based upon staffing and ingredients available.
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From page 309... ...
Implementation of the strategies related to consumers and behavior change must rest on a foundation of acceptance regarding the importance of reducing sodium intake. This can take the form of efforts to enhance consumer awareness of the importance of sodium reduction, as well as engaging consumers to be supportive of efforts to reduce sodium in the food supply.
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From page 310... ...
Nonetheless, FDA, as part of its regulatory implementation, will establish a time line for the reduction of sodium in the food supply. However, as a general matter and as described earlier in the context of needed coordination, it would be important to ensure that an informed process is put in place to establish initial time lines and goals for overall reductions in sodium intake among Americans and for carrying out the implementing tasks that are separate from those for reducing sodium in the food supply.
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From page 311... ...
It should also be acknowledged that reducing the sodium content of the food supply may incur significant reformulation costs for the industry that will likely be passed on at least in part to consumers. These overall costs, however, will be necessary to fully realize the public health benefits of reducing sodium intake.
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From page 312... ...
Further investigation of such topics may be highly valuable in determining whether reduced sodium exposure in early life can reduce prefer ences for high-sodium diets in adulthood and whether strategies to focus on early interventions should be pursued. • There is evidence to show that salt taste preferences can be changed in adulthood when sodium is reduced across all foods.
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From page 313... ...
Undoubtedly, heightened attention to such innovation could be sparked by regulatory efforts to reduce sodium throughout the food supply. Research needs in this area include the following: • For some products, there is a need to develop new methods to achieve palatability given reduced sodium content.
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From page 314... ...
Research needs relevant to this interest are often cited in consensus reports on diet and health, and generally focus on experimental research examining the fundamental factors involved in changing dietary behaviors and experimental and observational research examining the most important established and novel factors that drive changes in population health. All such efforts would assist in improving the support given to consumers for behavior change relative to sodium intake, but three specific research areas are highlighted below.
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From page 315... ...
An important re search area is the question of how behavior change models for sodium reduction can effectively be structured when the behavior in question is strongly motivated by the pleasure of taste. Monitoring Sodium Intake, Sodium in the Food Supply, and Salt Taste Preference There are a range of monitoring and surveillance research needs.
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From page 316... ...
Such methodologies might range from opportunities to link Universal Product Code-level sales data to information on the nutrient content of the food as stated on the Nutrition Facts panel, to the development of databases relative to the sodium content of foodservice menu items. • Research is needed to expand the development of and continue to validate brief salt taste tests to monitor changes in perception following reduction of salt in the food supply.
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