INTRODUCTION: Comparing nutrition labels and choosing lower sodium foods are tactics to help reduce excessive sodium intake, a major risk factor for hypertension. Our objective was to assess US adult consumers' reported use and perceived understanding of sodium information on nutrition labels by sociodemographic and health status. METHODS: We analyzed responses to questions from 3,729 adults aged 18 years or older participating in 2 national cross-sectional mail panel surveys in 2010. RESULTS: We found that 19.3% (95% confidence interval [CI], 17.2%-21.6%) of respondents agreed they were confused about how to figure out how much sodium is in the foods they eat; 57.9% (95% CI, 55.4%-60.5%) reported that they or the person who shops for their food buy items labeled low salt or low sodium; and 46.8% (95% CI, 44.3%-49.4%) reported they check nutrition labels for sodium content as a tactic to limit salt. Consumers with a high school education or less were more likely than college graduates to report they were confused about sodium content on labels (adjusted odds ratio [AOR], 1.9; 95% CI, 1.4-2.8) and less likely to check labels for sodium as a tactic to limit salt intake (AOR, 0.7; 95% CI, 0.6-0.98). CONCLUSION: Most survey respondents in our study reported buying low sodium food items. However, a higher proportion of respondents with low education than respondents with high education reported confusion with and less use of sodium content information, suggesting enhanced efforts may be needed to assist this group. Opportunity exists for health care professionals to educate patients about using and understanding nutrition labels and consuming a diet consistent with the Dietary Approaches to Stop Hypertension (DASH) eating plan.

The vast majority of Americans consume too much sodium, primarily from packaged and restaurant foods. The evidence linking sodium intake with direct health outcomes indicates a positive relationship between higher levels of sodium intake and cardiovascular disease risk, consistent with the relationship between sodium intake and blood pressure. Despite communication and educational efforts focused on lowering sodium intake over the last three decades data suggest average US sodium intake has remained remarkably elevated, leading some to argue that current sodium guidelines are unattainable. The IOM in 2010 recommended gradual reductions in the sodium content of packaged and restaurant foods as a primary strategy to reduce US sodium intake, and research since that time suggests gradual, downward shifts in mean population sodium intake are achievable and can move the population toward current sodium intake guidelines. The current paper reviews recent evidence indicating: (1) significant reductions in mean population sodium intake can be achieved with gradual sodium reduction in the food supply, (2) gradual sodium reduction in certain cases can be achieved without a noticeable change in taste or consumption of specific products, and (3) lowering mean population sodium intake can move us toward meeting the current individual guidelines for sodium intake.

Americans are consuming too much sodium and too little potassium. Decreasing sodium intake and increasing potassium intake can reduce the risk of high blood pressure, heart disease, and stroke, and can help control blood pressure. Registered dietitians (RD’s) may play a role in preventing disease by counseling clients about the importance of reducing sodium intake and increasing potassium intake. This paper discusses the impact of sodium and potassium intake on health and explains the role of the registered dietitian nutritionist (RDN) when counseling clients about reducing sodium intake and increasing potassium intake.

Restaurant foods can be a substantial source of sodium in the American diet. According to the Institute of Medicine, the significant contribution made by restaurants and food service menu items to Americans' sodium intake warrants targeted attention. Public health practitioners are uniquely poised to support sodium-reduction efforts in restaurants and help drive demand for lower-sodium products through communication and collaboration with restaurant and food service professionals and through incentives for restaurants. This article discusses the role of the public health practitioner in restaurant sodium reduction and highlights select strategies that have been taken by state and local jurisdictions to support this effort.

Excess sodium intake can lead to increased blood pressure. Restaurant foods contribute nearly a quarter of the sodium consumed in the American diet. The objective of the pilot project was to develop and implement in collaboration with independent restaurants a tool, the Restaurant Assessment Tool and Evaluation (RATE), to assess efforts to reduce sodium in independent restaurants and measure changes over time in food preparation categories, including menu, cooking techniques, and products. Twelve independent restaurants in Schenectady County, New York, voluntarily participated. From initial assessment to a 6-month follow-up assessment using the RATE, 11 restaurants showed improvement in the cooking category, 9 showed improvement in the menu category, and 7 showed improvement in the product category. Menu analysis conducted by the Schenectady County Health Department staff suggested that reported sodium-reduction strategies might have affected approximately 25% of the restaurant menu items. The findings from this project suggest that a facilitated assessment, such as the RATE, can provide a useful platform for independent restaurant owners and public health practitioners to discuss and encourage sodium reduction. The RATE also provides opportunities to build and strengthen relationships between public health care practitioners and independent restaurant owners, which may help sustain the positive changes made.

Approximately 90% of Americans aged 2 years or older consume too much sodium (1). The consumption of too much sodium increases blood pressure, which increases the risk for stroke, coronary heart disease, heart failure, and renal disease (2). Population-based strategies to reduce salt intake are cost-effective, can reduce blood pressure (3), and, according to the Institute of Medicine, are needed at national, state, and community levels (2). To improve food environments and reduce sodium intake at the community level, the Centers for Disease Control and Prevention (CDC) funds the Sodium Reduction in Communities Program (SRCP). This demonstration project supports communities in creating more healthful food environments and aims to expand the evidence base for effective community strategies to address sodium intake at the population level. In this article, we describe the role of communities and environments in influencing health and strategies being implemented and evaluated by SRCP communities.