National Salt Reduction Initiative A Voluntary Framework to Reduce Population Sodium Intake
National Conference of State Legislatures Friday, December 10, 2010 Phoenix, Arizona Christine Johnson, MBA Cardiovascular Disease Prevention and Control Program New York City Department of Health and Mental Hygiene
Cardiovascular Disease is Leading Cause of Death in U.S. 30
Pe ercentage (of all deaths)
25 20
15 10 5 0 Heart Disease
Malignant Neoplasms
Cerebrovascular
Chronic Low . Respiratory Disease
Unintentional Injury
Alzheimer's Disease
Deaths: Final Data for 2007. National Vital Statistics Reports. Vol. 58, No. 19, May 20, 2010. http://www.cdc.gov/NCHS/data/nvsr/nvsr58/nvsr58_19.pdf
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Blood Pressure Reduction Through Reduced Salt Intake Would Save Lives 4,000 Tens of thousands of lives saved
U.S. adults, 20-74 years m consumption (mg/dayy) Sodium
3,500 3,000 2,500
2005 U.S. Dietary Guidelines recommended limit for adults
2,000 1,500
Proposed 2010 USDG recommended limit for all adults. d l 2005 200 recommended d d limit li i for f people l with ih hypertension, blacks, middle aged and older
1 000 1,000 500 0 NHANES I 1971-74
NHANES II NHANES III NHANES IV NHANES 1976-80 1988-94 1999-00 2003-2006
Data from: Briefel RR, Johnson CL. Secular trends in dietary intake in the United States. Annu Rev Nutr. 2004;24:401-431; Institute of Medicine. Strategies to Reduce Sodium in the United States, 2010.
Most Salt Comes from Processed and Restaurant Foods
Processed and restaurant foods
12% While eating 6%
77% 5%
Source: Mattes, RD. Journal of American College Nutrition, 1991, 10:383-393.
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Impact of Annual Reductions: Comparison Across Various Interventions Coron nary Heart Disease Inciden nce
120,000
100,000 ,
80,000
60,000
40,000
20,000
0 Salt reduction: 3 Salt reduction: 3 g/day (low g/day (high estimate) estimate)
Smoking cessation
Weight loss
Statin therapy
Treatment of Hypertension
Intervention Source: Data from Bibbins-Domingo K et al. Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease. 2010. New England Jounral of Medicine. 362:590-9.
IOM Report Strategies to Reduce Sodium Intake Primary strategy: • FDA should initiate process to set mandatory national standards for the sodium content of foods
Endorsed voluntary strategies in the interim • “Voluntary strategies could achieve meaningful reductions of sodium intake prior to implementation off mandatory d t standards.” t d d ” • “Voluntary … public-private partnerships should continue during the time mandatory standards are being established.” Reference: Institute of Medicine. Strategies to Reduce Sodium Intake in the United States, 2010
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UK Salt Campaign • Goal: Reduce salt intake by 1/3 from 2005 to 2010 – More than 50 commitments from all sectors of the food industry – Gradual reductions across product categories
• Product salt reductions achieved – – – –
Heinz: 32% to 58% ↓ in some canned products Nestle: 25% ↓ in soup mixes and bouillons K ll Kellogg’s: ’ 50% ↓ in i some cereals l Kraft: 30% ↓ in cheese
• Population salt intake is encouraging: ~ 10% ↓ UK Food Standards Agency website. Accessed on 9/29/10 at http://www.food.gov.uk/healthiereating/salt/. Summary Table of Salt reduction Commitments. Accessed on 9/29/10 at http://www.food.gov.uk/multimedia/pdfs/saltcommitmentsmay2010.pdf
Goal: 20% Reduction in Sodium Intake in 5 Years Decrease sodium content in foods by 25% over 5 years
Decrease population sodium intake by ~ 20% over 5 years
Reductions will vary among food categories
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National Salt Reduction Initiative Restaurant Food Partners s
National Health Orgs, Cities States Cities, s
Quick Q i k service i Full service Food service Trade associations
Packaged Food Branded Private label Food service Retailers Trade associations
National Effort National Health Organizations • • • • • • • • • • •
American College of Cardiology American College of Epidemiology American Dietetic Association American Heart Association American Medical Association American Public Health Association American Society of Hypertension Association of Black Cardiologists Consumers Union InterAmerican Heart Foundation International Society of Hypertension in Blacks
• • • • • • • • •
Joint Policy Committee, Societies of Epidemiology Kaiser Permanente National Hispanic Medical Association National Kidney Foundation New York State Chapter, American College of Cardiology Preventive Cardiovascular Nurses Association Society for the Analysis of African-American Public Health Issues Texas Medical Association World Hypertension League
Local and State Health Associations • • • •
Association of State and Territorial Health Officials Council of State and Territorial Epidemiologists National Association of Chronic Disease Directors National Association of County and City Health Officials
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National Effort State Health Departments • • • •
• • • •
Alaska Department of Health and Human Services Arizona Department of Health Services California Department of Public Health Colorado Department of Public Health and Environment Delaware Department of Health and Social Services, Division of Public Health Hawaii State Department of Health Idaho Department of Health and Welfare, Heart Disease and Stroke Prevention Program Maine Center for Disease Control and Prevention Maryland Department of Health and Mental Hygiene Massachusetts Department of Public Health Michigan Department of Community Health Minnesota Department of Health New Mexico Department of Health
• • • • •
Baltimore City Health Department Boston Public Health Commission Broome County Health Department Chicago Department of Public Health District of Columbia Department of Health
• • • • •
• • • • • • • • • • • •
New Jersey Department of Health and Senior Services New York State Department of Agriculture & Markets New York State Department of Health North Carolina Department of Health and Social Services, Division of Public Health North Dakota Department of Health Northern Illinois Public Health Consortium Ohio Department of Health Oregon Department of Health and Human Services, Division of Public Health Pennsylvania Department of Health Tennessee Department of Health Washington State Department of Health West Virginia Department of Health and Human Resources; Bureau for Public Health
City/Local Health Departments • • • •
Los Angeles County Department of Public Health NYC Department of Health and Mental Hygiene Philadelphia Department of Public Health Public Health, Seattle and King County
Timeline 2009
2010
2011
2012
2013
2014
Meetings to set 2012 and 2014 category targets
Announce targets and industry commitments
January 15th Interim target date
January 15th Target date
IIndustry d submits b i baseline data
E l Evaluate 2012 category target achievements
E l Evaluate 2014 category target achievements
Baseline Evaluation
Follow up Evaluation
Measure NYC Population Sodium Intake
Measure NYC Population Sodium Intake
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Packaged g and Restaurant Food Strategies
Wide Range of Sodium in Similar Products
Raisin Bran 350mg sodium
Cinnamon Raisin Cereal 115mg sodium
3X amount of sodium
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Databases • Packaged Food Database • Merges national sales data and nutrition data data, • Analyzed top 80% of items by sales • Calculated sales-weighted mean and range of sodium
• Restaurant Food Database • Merges national market share data and publiclyavailable il bl nutrition t iti d data t ffor 50 llargestt quick i k service i restaurants (ranked by sales) • Calculated market share-weighted mean and range of sodium
Targets • 2012 and 2014 targets • 62 packaged food categories • 25 restaurant categories • Restaurant item maximum
• Proposed targets announced January 2010 • Final targets announced April 2010 with first set of company commitments
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Sample Category Sodium Distribution 40
2014 2012 400 mg 480 mg
Mean 531 mg
35
Frequency
30 25 20 15 10 5 0 0-100
101200
201300
301400
401500
501600
601700
701800
801900
9011000
10011100
11011200
Sodium (mg/100g)
Maximum Comparison to Top 10 QSR Chains 3000 2800 2600
Sodium (mg) per item
2400 2200 2000 1800
2012: 1,500 mg
1600 1400
2014: 1,200 mg
1200 1000 800 600 400 200 0 0
1
2
3
4
5
6
7
8
9
10
Restaurant
Note: One product (sodium = 3,540 mg) was omitted for clarity.
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Committing to Targets Commitments to a food category target i di t th indicate thatt a company’s ’ sales-weighted l i ht d mean sodium will be at or lower than the target by the target date. • Companies must commit to at least one target that they do not already meet • Companies must submit monitoring forms to track progress
NSRI Company Commitments Packaged Food: • • • • • • • • •
Boar’s Head Butterball Delhaize America Fresh Direct Furmano’s Goya Hain Celestial Heinz Hostess Brands
• • • • • • • • •
Kraft LiDestri Mars Food McCain Foods Premio Red Gold Snyder’s of Hanover Unilever White Rose
Restaurants: • • • •
Au Bon Pain Starbucks Subway Uno Chicago Grill
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Monitoring and Evaluation Food Content Monitoring • Packaged Food and Restaurant Food Databases • Baseline and target year • By food category and by company
• Industry data • Baseline and target year • Unit sales and nutrition data
Evaluation • 24-hour urinary sodium analysis from representative adult population • Baseline and target year
National Nutrition Database • IOM Recommendation • Key components: • Creation of a national database • Mandated industry reporting of nutrition information • Updated annually • Interface for easy public access • Able to be merged by UPC
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Conclusion • National sodium reduction through a comprehensive p p plan to engage g g industry y is crucial • If you want to learn more about participating in the NSRI, please let me know
• Databases that incorporate nutrition and sales data can assess changes in the food supply • Population sodium intake can successfully be measured through 24-hour urine collection
NYC Food Standards • Goal: To improve the nutrition quality of meals served by city agencies • Executive Order in 2008 • 260+ million meals and snacks per year
• Standards for all meals and snacks served by NYC agencies • Standards for all beverage vending machines on city property
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National Salt Reduction Initiative A Voluntary Framework to Reduce Population Sodium Intake
For NSRI Partnership Information Contact Julie Felder
[email protected]
nyc.gov/health/salt
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