US seeks to reduce sodium consumption by one third

The US Food and Drug Administration (FDA) has released draft guidance for the food industry that agency officials say could reduce the daily average intake of sodium in the US by a third.1 The voluntary guidelines apply to processed and packaged foods as well as restaurant foods and would be implemented over a decade.

Currently, the average sodium intake in the United States is 3400 mg/day, most of which comes from processed and prepared foods, not the salt shaker, FDA officials noted. If the proposed guidelines are adopted by the food industry, officials said, it will be possible to reduce US consumption of sodium gradually over 10 years to 2300 mg/day, an amount in line with current federal recommendations for the general population. Overconsumption of sodium is an important cause of hypertension, which affects one in three US adults, and is a major contributor to heart disease and stroke, officials said.

US health and human services secretary, Sylvia Burwell, said the guidelines will give consumers more control over their diet. “Many Americans want to reduce sodium in their diets, but that’s hard to do when much of it is in everyday products we buy in stores and restaurants,” she said. It is estimated that 70% of the sodium in the US diet comes from processed foods.

The guidance proposes reducing sodium content in foods in two phases: a short term phase to be implemented over two years and a long term phase to be implemented over 10 years. The FDA has divided foods into 150 categories, from breakfast cereals to frozen pizzas, and established sodium content targets for each category. For instance, the sodium content of ready-to-eat white bread and rolls, which currently averages 523 mg of sodium per 100 g, would drop to 440 mg/100 g in two years and to 300 mg/100 g in 10 years. The gradual reduction in sodium content would give companies time to reformulate their products and consumers time to adjust to less salty food, officials said.

Industry reaction to the guidelines has been mixed. Two industry giants, Nestlé (the largest food company in the world) and Mars, said they welcomed the new guidelines and would work with the FDA in their implementation. But, the Salt Institute, an industry group, charged that the FDA had ignored growing evidence that population-wide sodium reduction was unnecessary and potentially harmful, citing among other studies a pooled analysis of four large prospective studies published recently in the Lancet.2 “The issuance today of new ‘voluntary’ sodium reduction mandates by the FDA is tantamount to malpractice,” the institute said.

But in a viewpoint article in JAMA, Tom Frieden, director of the US Centers for Disease Control and Prevention, took issue with critics who argue sodium reduction efforts pose substantial health risks.3 Such arguments, Frieden wrote, are based “in part from a few studies with inconsistent findings at lower levels of estimated sodium intake” that “have fundamental flaws.”

The United Kingdom set voluntary sodium reduction targets in 2003, he noted, and by 2011 sodium intake in the UK had decreased by 15%.4 “During this same period, average blood pressure decreased, and, following no change in prior years, deaths from ischemic heart disease and stroke decreased by approximately 40%,” he wrote. In the US, reduction of sodium intake by 1200 mg/day as sought by the FDA guidelines would prevent up to an estimated 500 000 deaths and save an estimated $100bn (70bn; €90bn) in healthcare costs over a decade, he said.

The draft guidelines for the two year target are open for public comment for 90 days. The guidelines for the 10 year targets are open for comment for 150 days.