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BMJ No 7106 Volume 315 Letters Saturday 23 August 1997 Intersalt dataSodium contents of restaurant foods in United States are highEditor,The many articles on salt and hypertension in the BMJ of 18 May 1996 - including Fiona Godlee's insightful commentary on the salt industry(1) - were excellent. In the United States the salt and food industries continue to undermine advice by health authorities to reduce salt intake. For example, on 21 May 1996 JAMA issued a press release with the headline 'Reducing salt in diet has little effect on blood pressure.' The release neglected to mention that the meta-analysis, funded by the Campbell Soup Company's Institute for Research and Technology, found a significant drop in systolic blood pressure before the authors excluded the trials in which subjects were fed diets controlled by institutions.(2) The snowballing effect of such reports is insidious. Two weeks after JAMA's press release the New York Times ran an article declaring that, 'contrary to previous advice, recent studies indicate that salt is not the villain it was once said to be.' (3) The article later stated: 'doctors still caution people who suffer from hypertension - estimated to be 10 percent of the population - to cut way back on salt.' In fact, 25% of American adults (50-60% of adults aged 60 or older) have hypertension. The only 'authority' quoted in the article was Richard Hanneman, president of the Salt Institute. The United States has made some progress in reducing sodium levels in packaged foods. Our surveys indicate that these levels seem to be dropping at a rate of just over 1% a year.(4) However, Americans now spend nearly half of their food dollars on - and obtain a third of their energy from - foods eaten out of the home. There, sodium levels remain undisclosed and disturbingly high. The table shows the sodium contents that our nutritional analyses of restaurant foods (composites of nine to 12 samples purchased at mid-priced restaurants in at least three cities) have yielded for various selected entrees and meals.
These findings indicate that many Americans are exceeding, in a single meal, the 2400 mg of sodium recommended for an entire day. Only with the continued efforts of health authorities will the sodium content of restaurant foods and processed foods fall to safer levels. Bonnie F Liebman Director of nutrition Michael F Jacobson Executive director
Center for Science in the Public Interest, References 1 Godlee F. The food industry fights for salt. BMJ 1996;312:1239-40. 2 Midgley J P, Matthew A G, Greenwood C M T, Logan A G. Effect of reduced dietary sodium on blood pressure: a meta-analysis of randomized controlled trials. JAMA 1996;275:1590-7. 3 Hamlin S. Salt is regaining favor and savor. New York Times 1996 June 5:C1. 4 Jacobson M J, Liebman B F. Sodium in processed foods. Am J Clin Nutr 1996;63:138.
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