Relevant Sodium Reduction Publications

Institute of Medicine of the National Academies

Institute of Medicine Report on Strategies to Reduce Sodium Intake in the United States 2010. This report was supported by various agencies within the United States Department of Health and Human Services; specifically the Centers for Disease Control and Prevention (CDC), Food and Drug Administration, National Institutes of Health, and Office of Disease Prevention and Health Promotion. The Committee recommended the use of regulatory tools to gradually reduce sodium in foods "through a well-researched, coordinated, deliberative, and monitored process." Read more in the Report Brief or Download the Full Report.

Institute of Medicine Report on Reference Intakes for Water, Potassium, Sodium Chloride, and Sulfate 2005. In this report, data is put forth on the requirements for and the effects of sodium and chloride together. The Adequate Intake (AI) for sodium was set for young adults at 1.5 g/d. Read more in the Executive Summary or Download the Full Report.

Institute of Medicine Report on School Meals: Building Blocks for Healthy Children 2009. Congress required the United States Department of Agriculture (USDA) issue new guidance and regulations for Nutrition Standards and Meal Requirements of the National School Lunch Program (NSLP) and the School Breakfast Program (SBP). The USDA then requested the Institute of Medicine (IOM) provide recommendations to revise the nutrition- and food-related standards and requirements for NSLP and SBP. The IOM Committee on Nutrition Standards for National School Lunch and Breakfast Programs was asked to specifically review and assess the food and nutritional needs of school-aged children in the United States using the 2005 Dietary Guidelines for Americans and the IOM's Dietary Reference Intakes and to use that review as a basis for recommended revisions to the NSLP and SBP Nutrition Standards and Meal Requirements. The Committee recommended meal planning approaches that provide specifications on the maximum sodium content. In addition, the Committee recognized barriers to sodium reduction and suggested incentives be developed to encourage innovative ways to gradually reduce the sodium content in school foods. Read more in the Report Briefor Download the Full Report.

Institute of Medicine recommended meal requirements for the Child and Adult Care Food Program improved alignment with the Dietary Guidelines, including an increased emphasis on limiting sodium. Read more in the Report Brief or Download the Full Report.

Scientific Advisory Committee on Nutrition

A report was prepared in response to a request from the Food Standards Agency and the Chief Medical Officer of Wales. The report methodologically examines the national data on salt and health and provides recommendations for the government to take to facilitate sodium consumption in the United Kingdom. Salt and Health. 2003.

Journal of Food Science Research Articles

Batenburg M & van der Velden R. Saltiness enhancements by savory aroma compounds. J Food Sci. 2011;76:280-288. Study demonstrating that multisensory interaction between aroma and taste can be employed to compensate for the lower salt levels of healthier food products without disturbing the overall flavor pattern.

Lucas L, et al. The influence of sodium on liking and consumption of salty food. J Food Sci. 2011;76:S72-S76. Study found liking of hash browns was influenced by whether testing was in a lab or dining room environment. In a dining room, large decreases (>50%) of sodium content of food were achievable with only minor decrease in liking and no effect on consumption of the food.

Addesso KM & Kleyn DH. Development of an acceptable "ice cream " possessing a reduced sodium content. J Food Sci. 1986;51(6):1467-1470. A student panel found all whey-containing experimental products to be acceptable when compared to the control sample, a high quality vanilla ice cream containing nonfat dry milk solids as the only source of serum solids.

Barbut S, et al. Effects of sodium chloride reduction on polyphosphate addition onClostridium Botulinum toxin production in turkey frankfurters. J Food Sci. 1986;51(5):1136-1138. Turkey meat emulsions were made with lower sodium chloride solutions or combinations of 1.5% or 2.0% salt with 0.4% sodium tripolyphosphate (TPP), sodium hexa-metaphosphate (HMP), or sodium acid pyrophosphate (SAPP) and incubated with Clostridium Botulinum. Toxin production was detected earlier when TPP was added, HMP had no effect, and SAPP delayed toxin production.

Wyatt CJ. Acceptability of reduced sodium in breads, cottage cheese, and pickles. J Food Sci. 1983;48:1300-1302. Salt was reduced in cottage cheese and white and whole wheat breads. Commercial dill and sweet pickles with reduced salt were also included. Reducing the salt content of foods altered the Na:K ratio.

Berry BW & Blumer TN. Sensory, physical, and cooking characteristics of bacon processed with varying levels of sodium nitrite and potassium sorbate. J Food Sci. 1981;46:321-327. The degree of leanness in bacon strips had more of an influence on textural, physical, and cooking characteristics than did sodium nitrate and potassium sorbate levels.

Comprehensive Reviews in Food Science and Food Safety

Doyle ME & Glass KA. Sodium reduction and its effect on food safety, food quality, and human health. Comp Reviews in Food Science & Food Safety. 2010;9:44-56. This review considers published data on the apparent adverse health effects of excess salt intake, as well as the important functions of salt in different foods and possible strategies for reducing sodium levels in processed foods while still producing safe foods that consumers find acceptable.

Johnson ME, et al. Reduction of sodium and fat levels in natural and processed cheeses: Scientific and Technological Aspects. Comp Reviews in Food Science & Food Safety. 2009(8): 252-268. This review is primarily a report on the current status of research to develop desirable cheeses with low-fat and/or low-sodium, their regulatory and labeling status, consumer acceptability, and challenges for further efforts.

Food Technology Magazine Articles

Sheila Fleischhacker and Will Fisher provide highlights of IFT's comments to FDA/FSIS on Approaches to Reducing Sodium Consumption. IFT Comments on Sodium Reduction. Food Tech. 2012;Vol(Number)

Wayne Morley discusses innovative ways for reducing sodium. Novel Strategies for Reducing Sodium. Food Tech. 2012;66(1)

Janice Johnson discusses how the food industry is responding to consumer and government nudges for lower sodium products. Challenges of Formulating Products to Meet Desired Sodium Targets. Food Tech. 2011;65(6)

Toni Traver discusses how product developers are using a variety of tactics to reformulate lower sodium foods. Desalting the Food Grid. Food Tech. 2010;64(8)

Andrea Rosanoff and Roger Clemens discuss the role of the magnesium-sodium ratio in human health. Managing Magnesium in a Sodium-Dominant Era. Food Tech. 2010;64(6)

Barbara Katz and Lu Ann Williams discuss how consumers are reacting to lower sodium foods. Salt Reduction Gains Momentum. Food Tech. 2010;64(5)

Mary Ellen Kuhn discusses the Institute of Medicine's urge to use regulatory approaches to lower sodium in our nation's food supply. Strategies for Reducing Sodium in the U.S. Food Tech. 2010;64(5)

Iwan Brandsma discusses how European attitudes and regulations regarding sodium in foods poses challenges for the food industry. Reducing Sodium: A European Perspective. Food Tech. 2006;60(3).

Other Publications

2012

Dunford E, et al. The variability of reported salt levels in fast food across six countries: Opportunities for salt reduction. CMAJ. 2012[epub ahead of print]. Found substantial variation in salt content of fast foods chains operating in Australia, Canada, France, New Zealand, the United Kingdom and the United States.

Centers for Disease Control and Prevention. Second National Report on Biochemical Indicators of Diet and Nutrition in the U.S. Population 2012. Discusses public health issues, sources of information on nutrition monitoring, and data needs including sodium and iodine consumption

Centers for Disease Control and Prevention. Vital Signs: Food categories contributing the most to sodium consumption—United States, 2007-2008. February 7, 2012. Found bread and rolls were significant contributors to sodium consumption in American diets.

Mamenko M, et al. Angiotensin II increases activity of the epithelial Na+ channel (ENaC) in distal nephron additively to aldosterone. J Biol Chem. 2012;287(1):660-671. Ang II was found to directly control ENaC activity and expression in murine distal nephrons.

Ng SW & Popkin BM. Commentary: Monitoring foods and nutrients sold and consumed in the United States: Dynamics and challenges. J Acad Nutr Diet. 2012;112(1):41-45. Describes data sources available to monitor foods and nutrients sold and consumed in the US and details their strengths and limitations in terms of shaping public health policy.

Machura K, et al. Role of blood pressure in mediating the influence of salt intake on renin expression in the kidney. Am J Physiol Renal Physiol. 2012;302(10):F1278-F1285. Assessed the possible mediator role of preglomerular blood pressure in the control of renin expression by oral salt intake.

Malliot M & Drewnowski A. A conflict between nutritionally adequate diets and meeting the 2010 dietary guidelines for sodium. Am J Prev Med. 2012;42(2):174-179. Determined government sodium targets are incompatible with dietary guidelines.

Stein LJ, Coward BJ, & Beauchamp GK. The development of salty taste acceptance is related to dietary experience in human infants: A prospective study. Am J Clin Nutr. 2012;95:1123-1129. Found early dietary experiences shape salt preference of infants and preschoolers.

2011

Folkow B. On bias in medical research; reflections on present salt-cholesterol controversies. Scandinavian Cardiovascular J. 2011;45:194-197. Discussed the evidence the IOM used in developing its recommendations on sodium reduction.

Graudal N & Jurgens G. The sodium phantom. BMJ. 2011;343:d6119. Letter to editor response regarding Cappuccio and colleagues’ analysis.

Cappuccio FP, et al. Policy options to reduce population salt intake. BMJ. 2011;343:d4995. Puts forth policy approaches governments can take to reduce human consumption of sodium.

Koleganova N, et al. Both high and low maternal salt intake in pregnancy alter kidney development in the offspring. Am J Physiol Renal Physiol. 2011;301(2):F344-354 . Reported too little salt intake during pregnancy inhibits proper kidney development in offspring.

Graudal NA, Hubeck-Graudal T, Jurgens G. Effects of low-sodium diets vs. high-sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglycerdie (Cochrane Review). Am J Hypertension. 2011. doi:10.1038/ajh.2011.210. Study of low sodium diets versus high sodium diets found sodium reduction resulted in a significant decrease in blood pressure and a significant increase in plasma renin, plasma aldosterone, plasma adrenaline, and plasma noradrenaline.

Howlett E. Hold the Salt! Effects on sodium information provision, sodium content, and hypertension on perceived cardiovascular disease risk and purchase intentions. J Pub Policy & Marketing. 2011 doi: 10.1509/jppm.10.048. Two studies were reported together and found that hypertension status had a significant effect on consumers' attention to dietary sodium on the Nutrition Facts panel and moderates the influence of sodium disclosure on perceived cardiovascular disease risk and purchase intentions for restaurant items.

Graudal NA, Hubeck-Graudal T, Jurgens G. The Cochrane Collaboration. Effects of low sodium diets versus high sodium diets on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride (Review). John Wiley & Sons, Ltd; 2011. In this 2011 update, 167 studies were included and the authors concluded sodium reduction resulted in a 1% decrease in blood pressure in normotensives, a 3.5% decrease in hypertensives, a significant increase in plasma renin, plasma aldosterone, plasma adrenaline, and plasma noradrenaline, a 2.5% increase in cholesterol, and a 7% increase in triglyceride.

Grummer J & Schonenfuss TC. Determining salt concentrations for equivalent water activity in reduced-sodium cheese by use of a model system. J Dairy Sci. 2011;94:4360-4365. Study developed a model system to measure water activity directly without manufacturing cheese to allow cheese makers to determine the salt and salt replacer concentrations needed to achieve equivalent water activity for their existing full-sodium control formulas.

Whelton, PK. Editorial: Urinary sodium and cardiovascular disease risk: Informing guidelines for sodium consumption. JAMA. 2011;306:2262-2238. Editorial discusses the need to reduce dietary sodium and improve the sodium-potassium ratio.
O'Donnell MJ, et al. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA. 2011;306:2229-2238. Study found the association between estimated sodium excretion and cardiovascular events was J-shaped.

Centers for Disease Control and Prevention. Usual sodium intakes compared with current dietary guidelines--United States, 2005-2008. MMWR. 2011(60):41:1413-1417 . CDC provides population estimates meeting or exceeding Dietary Guidelines for Americans and those at risk.

2010

Alderman, MH. Commentary: Reducing dietary sodium: The case for caution. JAMA. 2010;303:448-449.
Dr. Alderman cautions against population-wide sodium reduction and suggests a more cautious approach is merited based on the need for more rigorous, large-scale, population-based randomized clinical trials. Study Abstract: http://jama.ama-assn.org/content/306/20/2262

Taormina P. Implications of salt and sodium reduction on microbial food safety. Critical Rev Food Sci & Nutr. 2010;50(3):209-227. Taromina of the John Morrell Food Group reviews the antimicrobial properties of sodium chloride in foods and the impact of salt and sodium reduction or replacement on microbiological food safety and quality.

Bibbins-Domingo, et al. Projected effect of dietary salt reduction on future cardiovascular disease. New Engl J Med. 2010;362(7):590-599 . Study used the Coronary Heart Disease Policy Model to quantify the benefits of population-wide sodium reductions and determined modest reductions in dietary salt could substantially reduce cardiovascular events and medical costs.

2009

Centers for Disease Control and Prevention. Application of lower sodium intake recommendations to adults—United States, 1999-2006. MMWR. 2009;58(11):281-283 . CDC provides population estimates meeting lower sodium intake recommendations.

Crepinske MK, et al. Meals offered and served in US public schools: Do they meet nutritional standards? J Am Diet Assoc. 2009;109:S31-S43. Study of 398 schools found most participating schools offered and served meals that met the standards for protein, vitamins, and minerals. Average levels of sodium were high.

Burton SE, et al. Food for thought: How will the nutrition labeling of quick service restaurant menu items influence consumers' product evaluations, purchase intentions, and choices? J Retailing. 2009;85(3):258-273 . Study reported consumers have little understanding of the level of sodium in foods, including healthier foods.

Palar K, & Sturm R. Potential societal savings from reduced sodium consumption in the US adult population. Am J Health Promot. 2009;24(1):49-57. A modeling study using population-level data calculated that reducing average population sodium intake to 2300 mg/day may reduce cases of hypertension by 11 million and save an estimated $18 billion in health care dollars.

2008

Dasgupta PK, et al. Iodine Nutrition: Iodine content of iodized salt in the United States. Environ. Sci. Technol. 2008;42(4):1315-1323 . Review discusses the recent literature on iodine sufficiency and discusses the implications for United States.

2007

Pietinen P, et al. Labelling the salt content in foods: A useful tool in reducing sodium intake in Finland. Public Health Nutrition. 2007;11(4):335-340. Found giving consumers information about salt content may help reduce consumption.

Cook NR, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: Observational follow-up of the trials of hypertension prevention (TOHP). BMJ. 2007;334(7599):885. A longitudinal study reported with sodium reduction interventions through comprehensive education and counseling with adults aged 30 to 54 with prehypertension can lower blood pressure and may reduce the risk of longer term cardiovascular events.

2006

Al-Awqati Q. Editorial: Evidence-based politics of salt and blood pressure. Kidney Int. 2006;69:1707-1708. Discusses the need for sodium and health research beyond epidemiological research.

2004

Nishida C, et al. The Joint WHO/FAO Expert Consultation on diet, nutrition, and the prevention of chronic diseases: Process, product, and policy implications. Public Health Nutrition. 2004;7(1A):245-250. Puts forth further research needs around sodium reduction and cardiovascular diseases.

Havas S, Rocella EJ, Lenfant C. Reducing the public health burden from elevated blood pressure levels in the United States by lowering intake of dietary sodium. Am J Pub Health. 2004; 94: 19-22. A commentary discusses how reducing sodium may impact the public health burden of elevated blood pressure levels.

2001

Wang, Q, et al. Compensatory up-regulation of angiotensin II subtype 1 receptors in alpha-ENaC knockout heterozygous mice. Kidney Int. 2001;59:2216-2221. Found that alpha-ENaC heterozygous mice had developed an unusual mechanism of compensation leading to an activation of the renin-angiotensin system and this up-regulation may be due to an increase in aldosterone production.

Sacks FM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med. 2001;344(1):3-10. Study finds the reduction of sodium intake to less than 100 mmol per day and the DASH diet both lower blood pressure.