The US government has announced plans to cut the country’s salt intake, a move some in campaign circles have been urging for nearly 40 years. The Food and Drug Administration’s voluntary targets attracted support from NGOs and parts of the industry, although, as Ben Cooper writes, the reaction was not entirely positive.

To say that the sodium reduction targets unveiled by the US Food and Drug Administration last week have been a long time coming would be something of an understatement. Consumer advocacy organisation Center for Science in the Public Interest traces its campaign for government action on sodium back to 1978, when it first urged the FDA to revoke salt’s GRAS (generally recognised as safe) status.

In the meantime, many countries have taken steps to reduce sodium consumption. According to campaign group World Action on Salt and Health, voluntary targets have been introduced in 33 countries around the world and a further nine countries have now mandated maximum sodium/salt limits for certain products.

The FDA’s approach is to establish “reasonable, voluntary reduction targets” for the majority of processed and prepared foods, grouping foods into around 150 categories from bakery products to soups. It said it was confident the short-term targets, aimed at decreasing sodium intake to about 3,000 mg per day, are “readily achievable”. The ten-year voluntary targets for industry are aimed at reducing sodium intake to 2,300mg per day, a level the FDA said was “recommended by leading experts and the overwhelming body of scientific evidence”.

The regulator has set a 90-day comment period in relation to the food product groupings, 2010 baseline levels and the two-year targets, and a 150-day period for submissions relating to the 10-year targets and a number of other questions.

A spokesperson for the Grocery Manufacturers Association, which represents US food producers, confirmed it “will be engaging in the dialogue with FDA in many ways, including conversations and written comments”.

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In its initial reaction to the FDA announcement, the GMA said optimal sodium intake levels should be based on the “most recent science” and the “health risks from consuming too little sodium” should also be taken into consideration.

“The DRI (Dietary Reference Intake) was established in 2005, and since then, a body of new research has provided results indicating the DRI is too low and needs to be re-evaluated,” a GMA spokesperson tells just-food. “We believe that a re-evaluation of the latest research by a group such as the Institute of Medicine is needed to determine the acceptable range of sodium intake for optimal health and whether the DRI needs to be updated.”

The chances of the GMA forcing a revision of the target intake levels at this stage appear slim. When making the announcement, Dr Susan Mayne, director of the FDA’s Center for Food Safety and Applied Nutrition, appeared to pre-empt the GMA’s critique, stressing “the totality of the scientific evidence supports sodium reduction from current intake levels”, and adding “experts at the Institute of Medicine have concluded that reducing sodium intake to 2,300 mg per day can significantly help Americans reduce their blood pressure and ultimately prevent hundreds of thousands of premature illnesses and deaths”.

Where the GMA may fare better is with regard to specific reduction targets for the different food products. There is a lot of detail here and arguably greater potential for some adjustments to be made. “We will be making more detailed comments on the targets for the food groups as the review and comment period unfolds,” the GMA spokesperson said.

Another possible reason why the GMA may have more success in gaining adjustments to the specific targets is they are voluntary measures. The FDA needs wholehearted engagement by industry to make this work, just as the Food Standards Agency in the UK, required – and by and large received – the support of food companies in pursuit of its reduction targets.

In responding to the FDA announcement, the CSPI appeared to accept the reduction targets being voluntary as a necessary compromise. “While this is a voluntary approach as opposed to the mandatory approach we asked for and that the Institute of Medicine endorsed, it provides clear goals by which companies can be held accountable,” CSPI president Michael Jacobson said.

Saadia Noorani, a nutritionist who leads the WASH world action programme, also stresses the importance of industry engagement. “In developed countries, 75% to 80% of dietary salt intake comes from the consumption of processed foods, it is therefore clear that the food industry has a vital role to play in reducing population level salt intake.”

While the reservations expressed by the GMA suggest a less than wholehearted endorsement, a number of major US food companies have been supportive of the FDA’s plans for salt reduction. PepsiCo, Mars, Nestle and Unilever joined with the Academy of Nutrition and Dietetics, the American Heart Association, the American Public Health Association and the CSPI last month in signing a letter to the chairman and a ranking member of the US Senate Committee on Appropriations Subcommittee on Agriculture, Rural Development, Food and Drug Administration and Related Agencies in support of voluntary sodium reduction targets.

In a statement last week in the wake of the FDA’s announcement, Mars said it “applauds FDA for releasing its draft voluntary guidelines on sodium”. Mars also said it had been working on reducing sodium in its products since joining the National Sodium Reduction Initiative in 2010, which speaks to why companies in the vanguard on sodium reduction are keen to see the FDA set targets. As the CSPI’s Jacobson suggests, the official targets help to “level the playing field for those companies that are already trying to use less salt in their foods”.

Taking a more aggressive stance, however, is the salt industry’s trade body, the Salt Institute. “The issuance today of new “voluntary” sodium reduction mandates by the FDA is tantamount to malpractice and inexcusable in the face of years of scientific evidence showing that population-wide sodium reduction strategies are unnecessary and could be harmful,” the organisation stated. Like the GMA, the Salt Institute urges the FDA to consider more recent research and points to the health risks of low sodium intake.

The Salt Institute also said “the history of government-issued voluntary sodium reduction targets in other countries shows that they are an abject failure”, although that is an assertion WASH firmly refutes. 

“The introduction of salt reduction targets by national governments has been successful in reducing population salt intakes,” Noorani says. “A good example is the UK where many food companies and retailers have successfully reformulated their products with a 20% to 40% reduction to meet the national government’s salt reduction targets.” 

WASH says the UK’s voluntary targets contributed to an 11% decline in average salt intakes in the country from 2005 to 2015. Voluntary salt reduction targets are also in place in Turkey where sodium intakes fell by 17% from 2008 to 2012 and in Slovenia where intake fell by 9% from 2007 to 2012, WASH states.

The GMA declined the opportunity to distance itself from the combative stance taken by the Salt Institute. When invited to do so, the GMA spokesperson responded: “Different groups have provided a wide range of comments and reactions to the guidelines.” He said there was “no reason” why the GMA would comment on the reactions of others and it remained “focused on GMA’s response – now and into the future – to the guidelines”. 

The tenor of the Salt Institute’s reaction means the GMA is likely to appear positive in comparison. However, with regard to their principal reservations, both the GMA and the Salt Institute are likely to be left unsatisfied when the comment period comes to an end. 

It may have taken the FDA a long time to get to this stage, but it now appears firmly committed to setting voluntary salt reduction targets and believes it has the evidence to justify the actions it has announced.