Opportunities and Challenges to Sodium Reduction in Food Service and Strategies to Foster Progress

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The objective of this project is to document the outcomes of a dialogue with leaders from the food service sector, government, and academia to understand the challenges and opportunities related to sodium reduction in the food service sector. This work related to the dynamics, initiatives, and challenges in the food service sector will help identify and communicate opportunities to foster progress with sodium reduction, inform public health initiatives around sodium and to track progress over time.

Scientific Editor: Paula Trumbo PhD, Liberty University, Lynchburg VA

Year: 2022

Read more:

Food Service Sector Sodium Dialogue

Perspective: Challenges and Strategies to Reduce the Sodium Content of Foods by the Food Service Industry

This work was supported by the IAFNS Sodium Committee.

Comparison of Food Category Contributors to Sodium Intake from Stores vs. Restaurants

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The FDA released the final voluntary sodium reduction guidance in 2021. The targets presented are applicable to both consumer packaged goods and prepared/restaurant foods. Research indicates that the sodium contribution of restaurant foods is greater than that of foods consumed at home, including processed foods. There is an opportunity to understand these contributions, in totality and at the food category level, using updated data – to better target sodium reduction efforts. Distinguishing the contribution of foods from at home (including processed foods from a grocery store) compared to away-from-home consumption is important, as emphasis on e.g., the restaurant sector may have the greatest impact on intake. In addition, understanding the specific food category contributors from each source may indicate that emphasis on specific foods differs for foods consumed at home compared to away-from-home. This could inform food development, recipe formulation, and dietary guidance. The SoFHI committee is supporting an analysis of NHANES 2017-2018 to test the hypothesis that the types of foods obtained from restaurants are associated with higher levels of sodium intake compared to the types of foods obtained from stores.

Institution: Food & Nutrition Database Research, Inc.
Principal Investigator: Debra R. Keast, PhD
Year Awarded: 2022

This work is supported by IAFNS Sodium Committee.

View this project on the Center for Open Science's Open Science Framework.

Broader Dietary Value of Food Category Contributors to Sodium Intake

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As noted in the 2020 Dietary Guidelines Advisory Committee report, there is significant overlap between food categories that contribute to sodium intake and to vegetable intake. To ensure appropriate and effective messaging, dietary guidance, and food development or modification, it is important to understand the totality of nutrients and food groups provided by commonly consumed high-sodium foods. This applies whether they are in excess or support meeting dietary recommendations. In this project, national health and nutrition survey data (NHANES) from 2017-2018 will be examined to identify the top food category contributors to sodium intake. The analysis will break out data by racial and ethnic groups, and by poverty-to-income ratio. Intake of these food categories will be evaluated for the contribution to food groups and nutrient intake relative to dietary recommendations. This information will provide clarity on the broader contribution of these foods to better inform dietary guidance and messaging.

Institution: University of Toronto
Principal Investigator: Mary L'Abbe, PhD
Year Awarded: 2021

This project is being supported by the IAFNS Sodium Committee.

Read more: Top Sodium Food Sources in the American Diet—Using National Health and Nutrition Examination Survey

View this project on the Center for Open Science’s Open Science Framework.

Mini Virtual Symposium on Sodium

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Guiding Principles for Sodium Reduction Strategies in Food: A Compendium

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Significant knowledge exists about sodium reduction in foods, some of which is captured in Food & Drug Administration guidance documents. But progress made to date has not been captured in a publicly accessible format, and where it is available, it is not in a domain typically accessed by the public health community. Developing a compendium of available tools—including their possibilities, challenges and nuances—relevant to product development would be informative across stakeholders with an interest in addressing this persistent public health concern. This project will result in a publication that will provide evidence-based tools available for sodium reduction, organized by specific food categories to conjoin the wide range of resources into a compendium relevant to food industry applications.

Institution: University of Illinois at Urbana-Champaign
Principal Investigator: Soo-Yeun Lee, PhD
Amount: $80,000
Year Awarded: 2020

Read more:

View this project on the Center for Open Science's Open Science Framework.

Access the Sodium Reduction Science and Strategies Database here.

Learn more about the IAFNS Sodium in Foods and Health Implications Committee.

Effect of the Use of Potassium-Based Sodium Replacers on Sodium and Potassium Intakes of the US Population

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Sodium intake in the US population exceeds recommendations, and efforts have long been underway to reduce the amount of sodium in foods. Salt in the form of NaCl is the largest source of sodium in processed foods. Given the particular roles NaCl plays in foods (functional, taste, food preservation), it is difficult to remove it either entirely or in large part. Potassium chloride (KCl) is one of the most effective tools for NaCl replacement, due to its ability to perform many of the functional roles of NaCl, and thus, sodium reduction in foods. Replacement of NaCl with KCl would also have the greatest impact on potassium intake, compared to other NaCl or sodium containing ingredient (e.g. potassium bicarbonate vs. sodium bicarbonate) replacement options.

This switch has the potential to alter intakes of both sodium and potassium. There is evidence that the Na-K ratio of the diet is relevant in blood pressure physiology, but to what extent reformulation efforts have or could affect intake of these nutrients, and as a secondary question, health, is unknown. In addition, there is concern that expanding the use of KCl will lead to unsafe potassium intake levels for certain high-risk groups (e.g., those with chronic kidney disease instructed to limit potassium intake). Several of these questions could be clarified through a population-based intake assessment.

The project will be conducted in three steps: 1) Identify the primary contributors to sodium intake using the FDA voluntary sodium reduction guidance, and 2) develop practical and feasible replacement scenarios for the identified categories, and 3) assess US population intakes of sodium and potassium for these categories under two scenarios: a) 100% replacement of NaCl with KCl, and b) “practical and feasible” replacement for each food category.

Institution: Exponent
Principal Investigator: Mary Murphy, MS, RD; Carolyn Scrafford, PhD, MPH
Year Awarded: 2019

Read more: Potassium Chloride-Based Replacers: Modeling Effects on Sodium and Potassium Intakes of the US Population with Cross-Sectional Data from NHANES 2015–2016 and 2009–2010

Read more: Targeting the Dietary Na:K Ratio--Considerations for Design of an Intervention Study to Impact Blood Pressure

View this project on the Center for Open Science's Open Science Framework.

Learn more about the IAFNS Sodium Committee.

Camp DASH Ancillary Studies

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The Camp DASH study trial will compare the effect of two dietary patterns and two levels of sodium intake on blood pressure and blood lipids in adolescents in the upper third of distribution for blood pressure. The two dietary patterns are based on the Dietary Approaches to Stop Hypertension (DASH) trial in adults. Purdue University is leading the trial, with sponsors and collaborators from Johns Hopkins, the Centers for Disease Control and Prevention, Johns Hopkins University, Indiana University School of Medicine, University of California, San Diego and National Heart, Lung, and Blood Institute (NHLBI). The IAFNS Sodium Committee is supporting 2 ancillary studies.

The ancillary studies will enhance the discoveries possible in the parent grant. The first ancillary study provides funding to allow 24-hour ambulatory blood pressure measurements (ABPM) in all study subjects. As 24-hour ABPM is becoming more standard in the evaluation of children with hypertension, and it can provide valuable information re: risk for target organ damage and CVD risk. Being able to determine the effect of diet quality and sodium reduction on these measures will enhance the knowledge gleaned from Camp DASH. The data provided is anticipated to influence future hypertension and CVD guidelines in pediatrics. The objective of the second ancillary study is to develop the capacity for measuring body sodium distribution. Sodium metabolism and distribution determines whether it impacts water retention, and therefore hypertension. The location of salt accumulation is a subject of debate and it only has been studied in adults. The fate of sodium accumulation among skin, soft tissues, and bone and racial differences in sodium regulation will be determined. Understanding sodium regulation and distribution in Camp DASH will help to understand the impact potential of diet on controlling hypertension.

Institution: Purdue University
Principal Investigator: Connie Weaver, PhD
Year Awarded: 2017

This project was part of a larger study that was terminated by Purdue University.

Learn more about the IAFNS Sodium Committee.