Report at a Glance

Recommendation 1: The Food and Drug Administration (FDA) should expeditiously initiate a process to set a mandatory national standards for the sodium content of foods.

• FDA should modify the generally recognized as safe (GRAS) status of salt added to processed foods in order to reduce the salt content of the food supply in a stepwise manner.
• FDA should likewise extend its stepwise application of the GRAS modification, adjusted as necessary, to encompass salt added to menu items offered by restaurant/foodservice operations that are sufficiently standardized so as to allow practical implementation.
• FDA should revisit the GRAS status of other sodium-containing compounds as well as any food additive provisions for such compounds and make adjustments as appropriate consistent with changes for salt in processed foods and restaurant/foodservice menu items.

Recommendation 2: The food industry should voluntarily act to reduce the sodium content of foods in advance of the implementation of mandatory standards.

• Food manufacturers and restaurant/foodservice operators should voluntarily accelerate and broaden efforts to reduce sodium in processed foods and menu items, respectively.
• The food industry, government, professional organizations, and public health partners should work together to promote voluntary collaborations to reduce sodium in foods.

Recommendation 3: Government agencies, public health and consumer organizations, and the food industry should carry out activities to support the reduction of sodium levels in the food supply.

• FDA and the U.S. Department of Agriculture (USDA) should revise and update—specifically for sodium—the provisions for nutrition labeling, related sodium claims, and disclosure or disqualifying criteria for sodium in foods, including a revision to base the Daily Value for sodium on the Adequate Intake.
• FDA should extend provisions for sodium content and health claims to restaurant/foodservice menu items and adjust the provisions as needed for use within the restaurant/foodservice sector.
• Congress should act to remove the exemption of nutrition labeling for food products intended solely for use in restaurant/foodservice operations.  
• Food retailers, governments, businesses, institutions, and other large-scale organizations that purchase or distribute food should establish sodium specifications for the foods they purchase and the food operations they oversee.
• Restaurant/foodservice leaders in collaboration with other key stakeholders, including federal, state, and local health authorities, should develop, pilot, and implement innovative initiatives targeted to restaurant/foodservice operations to facilitate and sustain sodium reduction in menu items.

Recommendation 4: In tandem with recommendations to reduce the sodium content of the food supply, government agencies, public health and consumer organizations, health professionals, the health insurance industry, the food industry, and public-private partnerships should conduct augmenting activities to support consumers in reducing sodium intake.

• The Secretary of Health and Human Services (HHS) should act in cooperation with other government and non-government groups to design and implement a comprehensive, nationwide campaign to reduce sodium intake and act to set a timeline for achieving the sodium intake goals established by the Dietary Guidelines for Americans.
• Government agencies, public health and consumer organizations, health professionals, the food industry, and public-private partnerships should continue or expand efforts to support consumers in making behavior changes to reduce sodium intake in a manner consistent with the Dietary Guidelines for Americans.

Recommendation 5: Federal agencies should ensure and enhance monitoring and surveillance relative to sodium intake measurement, salt taste preference, and sodium content of foods, and should ensure sustained and timely release of data in user-friendly formats.

• Congress, HHS/CDC (Centers for Disease Control and Prevention), and USDA authorities should ensure adequate funding for the National Health and Nutrition Examination Survey (NHANES), including related and supporting databases or surveys.
• CDC should collect 24-hour urine samples during NHANES or as a separate nationally representative "sentinel site" type activity.
• CDC should, as a component of NHANES or another appropriate nationally representative survey, begin work immediately with the National Institutes of Health (NIH) to develop an appropriate assessment tool for salt taste preference, obtain baseline measurements, and track salt taste preference over time.
• CDC in cooperation with other relevant HHS agencies, USDA, and the Federal Trade Commission should strengthen and expand its activities to measure population knowledge, attitudes, and behavior about sodium among consumers.
• FDA should modify and expand its existing Total Diet Study and its Food Label and Package Survey to ensure better coverage of information about sodium content in the diet and sodium-related information on packaged and prepared foods.
• USDA should enhance the quality and comprehensiveness of sodium content information in its tables of food composition.
• USDA in cooperation with HHS should develop approaches utilizing current and new methodologies and databases to monitor the sodium content of the total food supply.