Plenary vi sodium actions and insights from national forum members and stakeholders
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Plenary VI Sodium : Actions and Insights from National Forum Members and Stakeholders . National Salt Reduction Initiative - Elizabeth Leonard, MPH, Project Coordinator, New York City Department of Health and Mental Hygiene . Insights from the National Salt Reduction Initiative.

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Plenary vi sodium actions and insights from national forum members and stakeholders

Plenary VISodium: Actions and Insights from National Forum Members and Stakeholders

National Salt Reduction Initiative

- Elizabeth Leonard, MPH, Project Coordinator, New York City Department of Health and Mental Hygiene


Insights from the national salt reduction initiative

Insights from the National Salt Reduction Initiative

Elizabeth Leonard

Nutrition Strategy Program

Bureau of Chronic Disease Prevention and Tobacco Control

New York City Department of Health and Mental Hygiene

October 9, 2013


Plenary vi sodium actions and insights from national forum members and stakeholders

NSRI Overview

  • Partnership of 95+ city and state health authorities and national health organizations

  • Voluntary sodium targets following 100+ meetings with industry

  • Almost 30 companies committed to NSRI targets


Plenary vi sodium actions and insights from national forum members and stakeholders

Deaths Attributable to Total Effects of Individual Risk Factors

National Salt Reduction Initiative

-50,000

50,000

150,000

250,000

350,000

450,000

Source: Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, et al. (2009) The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors. PLoS Med 6(4). b. Effect of high dietary salt on cardiovascular diseases was estimated through its measured effects of systolic bp.c. Protective effects of alcohol use on cardiovascular diseases are its net effects. Regular moderate alcohol use is protective for IHD, ischemic stroke, and diabetes but any use is hazardous for hypertensive disease, hemorrhagic stroke, cardiac arrhythmias, and other cardiovascular diseases.


Plenary vi sodium actions and insights from national forum members and stakeholders

Most Salt Intake Comes from

Processed Foods

Processed and restaurant foods

77%

12%

While eating

6%

5%

Mattes, RD. Donnelly D. Relative Contributions of Dietary Sodium Sources. Journal of American College Nutrition, 1991, 10:383-393.


International attention to salt

International Attention to Salt

Finland

  • Requires high salt warnings for products that exceed a category-specific level, beginning in the 1990s

    United Kingdom

  • Coordinated voluntary national effort with sodium targets across 80 food categories for 2008 and 2010

  • 50+ commitments from all sectors of industry, future planning underway

    Australia

  • Food and Health Dialogue is currently releasing targets by category, on a rolling basis

    Pan American Health Organization / World Health Organization

  • Established an Expert Group that developed recommendations to reduce population-wide dietary salt intake


Plenary vi sodium actions and insights from national forum members and stakeholders

US Context

Institute of Medicine published report on Strategies to Reduce Sodium Intake in 2010:

  • Primary recommendation: mandatory limits on sodium

  • Interim recommendation: coordinated voluntary approach


Plenary vi sodium actions and insights from national forum members and stakeholders

NSRI Partners Across U.S.

  • State & City Health Departments

  • Health Organizations

  • Academy of Nutrition and Dietetics (ADA)

  • American College of Cardiology

  • American College of Epidemiology

  • American Heart Association

  • American Medical Association

  • American Public Health Association

  • American Society of Hypertension

  • Association of Black Cardiologists

  • Consumers Union

  • Health Power for Minorities (Health Power)

  • InterAmerican Heart Foundation

  • International Society on Hypertension in Blacks

  • Kaiser Permanente

  • National Forum for Heart Disease and Stroke Prevention

  • National Hispanic Medical Association

  • National Kidney Foundation

  • Partnership for Prevention

  • Preventive Cardiovascular Nurses Association

  • Public Health Law Center at William Mitchell College of Law

  • Society for the Analysis of African-American Public Health Issues

  • World Hypertension League

  • State Health Department

  • State Health Association

  • City or County Health

  • Department

State & Local Associations

  • Association of State and Territorial Health Officials

  • Association of State and Territorial Public Health Nutrition Directors

  • California Conference of Local Health Officers

  • Council of State and Territorial Epidemiologists

  • Mississippi Task Force on Heart Disease and Stroke Prevention

  • Missouri Activity for Activity and Nutrition

  • National Association of Chronic Disease Directors

  • National Association of County and City Health Officials

  • New York State Chapter, American College of Cardiology

  • Northern Illinois Public Health Consortium

  • Northwest Kidney Centers

  • South Carolina Institute of Medicine & Public Health

  • Texas Association of Local Health Officials

  • Texas Medical Association

  • Texas Salt Reduction Collaborative

  • Wisconsin Heart Disease and Stroke Alliance


Determining baseline sodium levels

Determining Baseline Sodium Levels

Built Databases: Contains nutrition and sales data for thousands of packaged and restaurant foods

Analyze Databases: Collecting this data exposed the variation of sodium across similar products

Whole Wheat Bread

480mg sodium

Whole Grain Bread

160mg sodium

3X amount of sodium


Plenary vi sodium actions and insights from national forum members and stakeholders

NSRI Strategy

  • Set Targets: Sodium targets set for 2012 and 2014 for each of the 62 packaged food and 25 restaurant food categories

    • Invite Commitments: 28 food companies are committed to the NSRI

    • Monitor changes: Analyze changes in sodium in foods over time


Plenary vi sodium actions and insights from national forum members and stakeholders

Category Sodium Distribution

2014 400 mg

2012 480 mg

Mean 530 mg


21 companies met 2012 nsri targets

21 Companies Met 2012 NSRI Targets

  • Food Retailers

  • Delhaize America

  • FreshDirect

  • Target Corporation

Restaurant Food

  • Au Bon Pain

  • Starbucks

  • Subway

  • Uno Chicago Grill

Packaged Food

  • Butterball

  • Furmano Foods

  • Goya Foods

  • Heinz

  • Ken’s Foods

  • Kraft Foods

  • LiDestri Foods/ Francesco Rinaldi

  • Mars Food

  • McCain Foods

  • Mondelēz International

  • Red Gold

  • Snyder’s-Lance

  • Unilever

  • White Rose


How we assess progress

How We Assess Progress

  • Track changes in sodium content of packaged and restaurant food in 2012 and 2014 using:

    • Packaged and Restaurant Food Databases

    • Industry-reported data

    • Implement baseline and follow up 24-hour urinary evaluation


Next steps for the nsri

Next Steps for the NSRI

  • Track changes in sodium content of packaged and restaurant food

  • Invite companies to commit to 2014 targets

  • Expand NSRI partnership through continued collaboration with national health organizations, cities, and states and continued coordination with federal agencies


Thank you elizabeth leonard eleonard1@health nyc gov

Thank YouElizabeth [email protected]


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