Abstract
Objectives. To determine the extent to which reductions in sodium during the National Salt Reduction Initiative (NSRI) target-setting period (2009–2014) continued after 2014.
Methods. We used the NSRI Packaged Food Database, which links products in the top 80% of US packaged food sales to nutrition information, to assess the proportion of products meeting the NSRI targets and the sales-weighted mean sodium density (mg/100 g) of 54 packaged food categories between 2009 and 2018.
Results. There was an 8.5% sales-weighted mean reduction in sodium between 2009 and 2018. Most change occurred between 2009 and 2012, with little change in subsequent years. The proportion of packaged foods meeting the 2012 and 2014 targets increased 48% and 45%, respectively, from 2009 to 2012, with no additional improvements through 2018.
Conclusions. Food manufacturers reduced sodium in the early years of the NSRI, but progress slowed after 2012.
Public Health Implications. The US Food and Drug Administration just released 2.5-year voluntary sodium targets for packaged and restaurant food. Continued assessment of industry progress and further target setting by the Food and Drug Administration is crucial to reducing sodium in the food supply.
There is widespread agreement that the US population’s sodium intake is too high. Between 1999–2000 and 2015–2016, median sodium intake among US adults increased slightly, and in 2015–2016, more than three quarters of adults exceeded the recommended daily upper limit for sodium.1–7 High sodium intake increases the risk of hypertension, a major cause of heart disease and stroke.5 In 2012, adults with sodium intake of more than 2 grams per day contributed to approximately 9.5% of cardiometabolic deaths and $3.8 billion in health care costs.8,9 In 2010, it was estimated that a 40% reduction in sodium in the US population would reduce cardiovascular disease deaths by 20%, averting 1.2 million deaths from cardiovascular disease by 2020.10
Reducing sodium intake will require changes to the US food supply. The vast majority (71%) of sodium comes from salt added to packaged and restaurant foods rather than salt occurring naturally or added at the table.11 Interventions targeting individual behavior change, such as dietary counseling, labeling, and educational campaigns, are more likely to reduce sodium intake when combined with structural interventions, such as concerted efforts by the food industry to reduce sodium added to their products.12,13
In 2005, to achieve a voluntary global target of less than 2 grams of sodium per day by 2025, the World Health Organization called on member states to engage food manufacturers in reducing sodium. To achieve that target, more than 75 countries have developed salt reduction strategies, some resulting in large reductions in population sodium intake.13,14 For example, between 2003 and 2010, the United Kingdom reduced adult sodium intake by 15% by setting voluntary sodium reduction targets, launching a public awareness campaign, and implementing a voluntary front-of-package sodium-labeling program.15,16 In 2021, the World Health Organization announced global sodium benchmarks for packaged food categories.17
Inspired by sodium reduction efforts in the United Kingdom, the US sodium reduction strategy has been led by the National Salt Reduction Initiative (NSRI), a coalition of more than 100 health organizations coordinated by the New York City Department of Health and Mental Hygiene (“Health Department”). The NSRI was launched in 2009 with the goal of achieving a 20% reduction in population sodium intake by 2014. Through analysis of national sales data, meetings with industry, and a public comment period, the Health Department set voluntary sodium reduction targets, which varied by category but amounted to an approximately 10% reduction in sodium by 2012 (“2012 targets”) and 25% reduction by 2014 (“2014 targets”) in 62 categories of packaged foods and 25 categories of restaurant foods.18,19 By 2014, 26% of packaged food categories met the 2012 targets and 3% met the 2014 targets; between 2009 and 2014, a 7% decline in sales-weighted mean sodium in US packaged foods was observed.20 Cogswell et al. estimated that if food companies had met the 2014 packaged and restaurant food targets, the usual mean daily sodium intake in the US population would have declined 20%—from 3417 milligrams to 2719 milligrams.21
The NSRI highlighted the opportunity for the Food and Drug Administration (FDA) to set short- and long-term targets, solicit further company commitments, and monitor sodium in the food supply through a publicly accessible database; however, the federal government was slow to act. In 2010, the Institute of Medicine urged the FDA to adopt mandatory sodium reduction targets for industry, citing the NSRI as a model framework.18 In response, the FDA and the US Department of Agriculture (USDA) issued a request for comments on strategies to reduce sodium; approximately 1500 comments were submitted in response to this request.22 A public meeting was held in November 2011, and in June 2016, the FDA released draft 2- and 10-year voluntary targets with opportunity for public comment.23 In October 2021, the FDA announced voluntary 2.5-year sodium guidance (means and maxima) for packaged and restaurant food categories.24
Studies have evaluated the effects of government salt reduction strategies on changes to the food supply, but there are limited data on the sustainability of sodium reduction initiatives without continued industry engagement and government oversight. We used 2009 to 2018 NSRI food supply data to examine changes in sodium in US packaged foods during (2009–2012 and 2012–2014) and after the end of (2014–2018) the NSRI—when no targets for industry were set. We also examined the feasibility of continued sodium reduction through product reformulation and innovation. We provide recommendations for an effective sodium reduction strategy with strong federal government support.
METHODS
The Health Department created the NSRI Packaged Food Database (“the database”) to monitor packaged food industry progress toward the 2012 and 2014 sodium reduction targets. The database linked products in the top 80% of national sales in 61 NSRI packaged food categories to nutrition information in 2009, 2012, 2014, and 2018. We acquired national sales data from Nielsen ScanTrack for the preceding 52-week period in each year and included weekly product-level sales from large grocery stores (i.e., grocery retailers with > $2 million in annual sales).
We calculated the total equivalized unit sales for each product by multiplying product size by units sold. We matched branded products in the top 80% of unit sales in each category to nutrition information by UPC (universal product code), a unique product identifier. We excluded private label products (20% of US food dollar sales in 2020).25 Nutrition information came from Guiding Stars, a proprietary nutrition rating system that maintains a database of nutrition facts labels for more than 100 000 packaged foods, and Label Insight, an open data source of more than 400 000 products purchased in the United States. If no match was found in either database, we searched for product nutrition facts labels on manufacturer or grocery store Web sites.
Packaged Food Sample
Sodium reduction targets were set for 62 packaged food categories; 1 category lacked sales data so we did not include it in the database. We grouped the 61 remaining categories into 15 metacategories, which included all branded products in the top 80% of sales in each category with available sales, sodium, and serving size information (n = 6336 in 2009, n = 6898 in 2012, n = 7396 in 2014, n = 7381 in 2018). On average, products included in the 61 categories represented 87% of branded top-selling products (84% in 2009, 86% in 2012, 89% in 2014, and 89% in 2018; Table 1). When estimating changes in sales-weighted mean sodium density over time, we excluded 7 categories (1 metacategory) that reported serving sizes by volume or units rather than by weight and 1 category that reported sales in dollars rather than units.20
TABLE 1—
Characteristics of US Packaged Foods in the National Salt Reduction Initiative Packaged Food Database: 2009–2018
| Metacategory | 2009, No. (%)a | 2012, No. (%)a | 2014, No. (%)a | 2018, No. (%)a | Products Sold by Committed Companies in 2009, No. (%) | Market Share of Products Sold by Committed Companies in 2009, % |
| Overall | 6336 (84) | 6898 (86) | 7396 (89) | 7381 (89) | 1568 (25) | 18.0 |
| Bakery | 1333 (80) | 1571 (80) | 1556 (80) | 1607 (81) | 290 (22) | 11.0 |
| Canned fish | 36 (59) | 33 (97) | 35 (97) | 45 (100) | 0 (0) | 0.0 |
| Cereal | 200 (97) | 230 (97) | 260 (99) | 269 (99) | 1 (0.5) | 0.2 |
| Dairy | 389 (90) | 374 (89) | 391 (88) | 364 (90) | 188 (48) | 27.4 |
| Fats and oils | 326 (92) | 266 (82) | 298 (96) | 326 (97) | 197 (60) | 40.6 |
| Legumes | 141 (81) | 143 (87) | 185 (93) | 178 (95) | 26 (18) | 7.6 |
| Meats | 841 (75) | 858 (73) | 1001 (85) | 924 (83) | 134 (16) | 15.0 |
| Mixed dishes | 1400 (88) | 1571 (93) | 1653 (94) | 1616 (95) | 238 (17) | 12.0 |
| Nut butters | 32 (97) | 34 (100) | 55 (98) | 43 (100) | 11 (34) | 13.6 |
| Potatoes | 108 (84) | 127 (91) | 143 (91) | 133 (86) | 51 (47) | 37.1 |
| Sauces | 510 (86) | 520 (84) | 585 (86) | 626 (90) | 198 (39) | 35.5 |
| Seasoning mixes | 49 (98) | 34 (92) | 45 (92) | 44 (98) | 2 (4) | 6.0 |
| Snacks | 494 (91) | 609 (93) | 662 (93) | 671 (92) | 59 (12) | 4.8 |
| Soup | 236 (89) | 278 (99) | 289 (91) | 304 (98) | 131 (56) | 43.0 |
| Vegetables | 241 (85) | 250 (99) | 238 (96) | 231 (95) | 42 (17) | 12.2 |
Indicates no. (%) of products with sodium and serving size information available out of all branded products in the top 80% of sales.
Measures
To assess industry progress toward the sodium reduction targets, we tabulated the number and percentage of products meeting the 2012 and 2014 targets in each year for all 61 categories and 15 metacategories. In the 54 categories with consistent unit sales by product weight, we also estimated changes in sales-weighted mean sodium density from 2009 to each subsequent year overall and by metacategory. To assess category turnover, we tracked products in the top 80% of sales in 2009 through 2018 and classified them into 4 mutually exclusive groups. Products in the top 80% of sales at all time points were “high market share” products. In high market share products, we considered items to be “reformulated” if sodium density changed from 1 time point to the next; otherwise, we labeled products “same.” We labeled products “discontinued” if they no longer appeared in the sales data in 2018 and “low market share” if they fell out of the top 80% of sales at any time point after 2009 but were not discontinued. “New” products were those that were not in the sales data in 2009 but were in the top 80% of sales in any subsequent year.
Statistical Analysis
We ran generalized linear regressions with binomial family and identity link to estimate the percentage of products meeting the 2012 and 2014 NSRI targets in 2009, 2012, 2014, and 2018. The independent variable was an indicator for year, and the dependent variable was an indicator for whether the product met the target. We used postregression estimation to compare means in each year to those in the previous year. Next, we used generalized linear regressions with a normal distribution and identity link to assess whether sales-weighted mean sodium density changed significantly over time. The 3 indicator variables for years 2012, 2014, and 2018 were the independent variables (with 2009 as the reference year), and product sodium density (mg/100 g) was the dependent variable. We weighted regressions by each product’s percentage unit sales in the sales category, and we used postregression estimation to compare means in each year to those in the previous year. We used a similar statistical analysis to assess product reformulation and innovation. To assess reformulation, we limited the analytic sample to high market share products (products in the top 80% of sales at each time point). To assess innovation, the analytic sample included all products in the top 80% of sales in 2009 (the reference group) and products newly introduced to the market and in the top 80% of sales in 2012, 2014, and 2018. For all analyses in which some products existed in multiple years, we applied generalized estimating equations to account for correlation among products in the database. We conducted all statistical analyses in SAS version 9.4 (SAS Institute, Cary, NC).
RESULTS
The number of branded products with sodium and serving size information in the top 80% of sales increased from 6336 in 2009 to 7381 in 2018 (Table 1). The proportion of products with complete sodium and serving size information was similar at each time point, ranging from 84% in 2009 to 89% in 2018.
By 2014, 23 companies had publicly committed to targets in at least 1 NSRI packaged food category. In 2009, products sold by committed companies accounted for 25% of products in the database and 18% of market share. Market share of products sold by committed companies at baseline ranged from 0.0% (canned fish) to 43.0% (soup). Products sold by committed companies accounted for more than one quarter of market share in the dairy (27.4%), potatoes (37.1%), sauces (35.5%), and fats and oils (40.6%) metacategories.
Changes in Sodium
Between 2009 and 2018, the sales-weighted mean sodium density of US packaged foods decreased 8.5%, from 591 milligrams per 100 grams in 2009 to 541 milligrams per 100 grams in 2018 (Figure 1). Most changes occurred between 2009 and 2012, during which time there was a 5.1% decrease in sodium (mean difference = −30 mg/100 g; 95% confidence interval [CI] = −20, −40; P < .001). There was less change between 2012 and 2014 (mean difference = −10 mg/100 g; 95% CI = −20, −1; P = .037) and between 2014 and 2018 (mean difference = −10 mg/100 g; 95% CI = −16, −4; P = .002).
FIGURE 1—
Change in the Percentage of US Packaged Foods Meeting the National Salt Reduction Initiative (NSRI) 2012 and 2014 Targets, and Sales-Weighted Mean Sodium Density: 2009–2018
Note. Results are from the authors’ analysis of packaged foods in the NSRI Packaged Food Database, 2009–2018. Sales-weighted means were estimated in each year by regressing sodium density on year and weighting by market share. The percentage of products meeting targets in each year were estimated by regressing an indicator for whether the product met the target on year. Generalized estimating equations accounted for products appearing in multiple years.
*P < .05; **P < .01; ***P < .001.
Between 2009 and 2018, the proportion of US packaged foods meeting the 2012 NSRI targets increased 47.7%, from 27.7% in 2009 to 40.9% in 2018, and the proportion of US packaged foods meeting the 2014 targets increased 44.9%, from 13.6% in 2009 to 19.7% in 2018. All improvements took place between 2009 and 2012, during which time the proportion of US packaged foods meeting the 2012 targets increased 44.8% (mean difference = 12.4%; 95% CI = 10.2, 14.6; P < .001), and the proportion of US packaged foods meeting the 2014 targets increased 46.3% (mean difference = 6.3%; 95% CI = 4.7, 8.0; P < .001). There were no further changes between 2012 and 2014 or between 2014 and 2018 overall, although there was some variation by metacategory (Tables A and B [available as a supplement to the online version of this article at http://www.ajph.org]).
Product Reformulation and Innovation
Of the 6336 foods that were in the top 80% of sales in the NSRI database in 2009, 2407 (38%) were high market share products, meaning they were in the top 80% of sales in their category in 2009, 2012, 2014, and 2018 (Figure 2). Of these foods, 2013 (84%) were reformulated between 2009 and 2018, and 394 (16%) did not change. Discontinued products accounted for less than 1% (n = 29) of products, and 3900 (62%) products were low market share, meaning they were sold at all time points but not consistently in the top 80% of category sales. After 2009, 4921 new products were introduced and in the top 80% of category sales.
FIGURE 2—
Reformulation, Innovation, and Discontinuation of US Packaged Foods in the National Salt Reduction Initiative (NSRI) Packaged Food Database: 2009–2018
Note. Results are from the authors’ analysis of products in the NSRI Packaged Food Database, 2009–2018. The top bar represents all products in the database in 2009. Products in the top 80% of sales at all time points with 0%–1% change in sodium density are labeled “same.” Products in the top 80% of sales at all time points with > 1% change in sodium density were labeled “reformulated.” Products were labeled “discontinued” if they no longer appeared in the sales data in 2018. Products were labeled “low market share” if they fell out of the top 80% of sales at any time point after 2009 but were not discontinued. “New” products were not in the sales data in 2009 but in the top 80% of sales in any subsequent year.
Among high market share products, sales-weighted mean sodium density declined 5.5% from 2009 to 2012 because of product reformulation (mean difference = −32 mg/100 g; 95% CI = −40, −23; P < .001; Table 2). There was a less than 1.5% decline in sodium from 2012 to 2014 (mean difference = −8 mg/100 g; 95% CI = −15, −1; P = .029) and no further reduction between 2014 and 2018 (mean difference = −4 mg/100 g; 95% CI = −9, 1; P = .1). Although this pattern was consistent across the majority of metacategories, there were some outliers. For example, sodium in nut butters decreased substantially between 2014 and 2018 (mean difference = −36 mg/100 g; 95% CI = −52, −21; P < .001), with no significant changes in previous years (Table D [available as a supplement to the online version of this article at http://www.ajph.org]).
TABLE 2—
Sales-Weighted Mean Sodium Density of US Packaged Foods in Top 80% of Sales (High Market Share Products) in 2009, 2012, 2014, and 2018 and Foods New to the Market (New Products): 2012, 2014, and 2018
| Sales-Weighted Mean (SE) Sodium Density (mg/100 g) | ||||
| 2009 | 2012 | 2014 | 2018 | |
| High market share products | 580 (13.1) | 548 (12.4)*** | 540 (11.8)* | 536 (11.7) |
| New products | 591 (3.9) | 567 (10.6)* | 566 (9.5) | 571 (12.4) |
Note. Results from authors’ analysis of products in the National Salt Reduction Initiative (NSRI) Packaged Food Database, 2009–2018. For “high market share products,” means were estimated from regressions of sodium density on an indicator for year, weighted by market share. The sample is all products in the top 80% of sales in 2009, 2012, 2014, and 2018 (n = 2214). For “new products,” means were estimated from regressions of sodium density on an indicator for whether the product was in the top 80% of sales in 2009 (n = 5938), newly introduced in 2012 (n = 1166), newly introduced in 2014 (n = 1429), or newly introduced in 2018 (n = 1098), weighted by market share.
*P < .05; **P < .01; ***P < .001.
Products new to the market in 2012 in the top 80% of sales were 4.1% lower in sodium than were products in the top 80% of sales in 2009 (mean difference = −24 mg/100 g; 95% CI = −46, −2; P = .036). There were no further reductions in sodium in newly introduced products in subsequent years overall, but again, there was some variation by metacategory. For example, mixed dishes (e.g., frozen, refrigerated, or canned entrées and side dishes) introduced to the market between 2014 and 2018 were 14.5% lower in sodium than were new products in 2012 to 2014 (mean difference = −67 mg/100 g; 95% CI = −100, −34; P < .001; Table E [available as a supplement to the online version of this article at http://www.ajph.org]).
DISCUSSION
We found an 8.5% sales-weighted mean reduction in sodium in 54 packaged food categories sold at large grocers between 2009 and 2018, which manifested as a modest reduction in sodium between 2009 and 2012 (5.1%), and less change between 2012 and 2014 (1.8%) and 2014 and 2018 (1.8%). The proportion of packaged foods meeting the 2012 and 2014 targets increased by nearly 50% from 2009 to 2012, but there were no additional improvements through 2018. Among top-selling products, sales-weighted mean sodium density declined by 5.5% from 2009 to 2012, declined by 1.5% from 2012 to 2014, and plateaued in subsequent years. Products new to the marketplace in 2012 were 4.1% lower in sodium than were products in 2009, but we observed no further reductions in sodium among new products introduced in 2014 or 2018. These results suggest that food manufacturers reduced sodium in the early years of the NSRI, but progress slowed over time. On average, there was little progress toward sodium reduction after 2014, a time during which no formal targets were in place. Although there was some variation in the timing and magnitude of sodium reduction across food categories, few categories had a significant change in mean sodium content between 2014 and 2018 and no categories saw their largest reductions in sodium during this period.
Early industry changes in sodium from 2009 to 2012 may be explained by the launch of the NSRI, which received widespread media attention, and the broader political context in which the NSRI was initiated. This was a pivotal time in US sodium policy, marked by the Institute of Medicine’s 2010 report recommending mandatory federal targets,18 the FDA–USDA 2011 docket and public meeting, striving toward a nationwide sodium reduction strategy,22 and stricter sodium limits for the USDA National School Lunch Program.26 The anticipation of regulatory oversight is a common cause of industry self-regulation. The attention from the FDA and the USDA leading up to 2012, in combination with voluntary commitments sought by the NSRI, may have motivated early industry efforts. In 2016, the FDA released draft sodium targets for industry with a public comment period and some discussion on the release of final targets23; however, federal momentum toward sodium reduction targets slowed until the release of final targets in 2021. During the period before the 2021 release, the FDA broadened its focus to include added sugars,27 and the USDA rolled back sodium standards for school meals.28
The NSRI was designed as a framework on which federal targets could be modeled, and our findings add to previous research showing that the initiative is a feasible approach to reducing sodium in the US food supply.20 A wide and diverse group of companies publicly joined the initiative, ranging from large multinational food companies to small businesses, which included manufacturers, distributors, retailers, and foodservice providers. Most companies that joined the initiative met the targets in the categories to which they committed, using a range of strategies, including reformulation of popular foods and innovation of new, lower sodium products. Reductions in sodium occurred in categories with and without public commitments, suggesting that these benchmarks carried weight for the industry overall, not only for companies that were formally engaged. The NSRI approach relied on (1) providing feasible benchmarks that industry could use widely for reformulation and new product development, (2) monitoring progress toward the targets over time, and (3) seeking voluntary adoption of those targets. Although there were modest reductions in sodium during the NSRI period, there was virtually no change following 2014. National targets—if they are closely monitored and iteratively reduced—will encourage more sustained and larger scale shifts that will improve the public’s health.
Limitations
Our study had a few limitations. First, this was an observational study, and we could not definitively attribute changes in sodium to the NSRI. Rather, as previously discussed, it is likely that progress during the initiative also resulted from the anticipation of federal action. Changes in sales-weighted mean sodium density may also be attributable to consumers selecting lower sodium products, a behavior change that may have resulted from labeling initiatives and mass media campaigns that ran concurrent with the NSRI.
Second, national sales data from mass merchandisers (e.g., Walmart), club stores (e.g., BJs), and small stores were not available, so we did not include them in the NSRI database. This may have led to the exclusion of products sold only in small grocers or mass merchandisers and may have led to overestimating the number of products defined as new if these products were previously sold in other store types and later expanded to large grocery stores. We do not, however, have reason to believe that the lack of mass merchandiser data would have a large impact on changes in sodium over time; in a sensitivity analysis, we purchased data from mass merchandisers for 3 categories of foods in 2018 and found no meaningful differences in sales-weighted mean nutrient values, top manufacturers in each category, or top products in each category by market share. In 2013, the mean sodium density of packaged food purchases from Walmart was very similar to that of food purchases from other retailers, although there was a slightly larger decline in the sodium density of Walmart purchases compared with other food retail purchases from 2009 to 2013, which may have biased our results toward the null, at least in the early years of the NSRI.29
Third, results could be affected by products missing sodium density information. Based on our analysis of missing data, products without sodium or serving size information tend to have less market share and potentially higher sodium density than do products with complete data. Fourth, the database excludes private label products, products in the bottom 20% of sales in each category, and products in non-NSRI categories. Lastly, we did not examine changes in sodium in restaurant foods, which made up an increasing share of food expenditures until 2020.30 Other research has shown that, after 2012, there was a reduction in sodium in newly introduced menu items but no change in sodium in common or “core” menu items in the top US chain restaurants.31
Public Health Implications
Evidence from global initiatives shows that industry engagement in sodium reduction can improve public health, particularly when targets are mandated and efforts are multipronged.13 At least 11 countries have implemented mandatory maximum levels of sodium in 1 or more food categories (mostly breads), and 2 countries—Argentina and South Africa—have implemented mandatory targets across a range of food categories.32 In 2013, following a 2-year voluntary salt reduction program, the Argentinian government set maximum sodium levels in meats, farinaceous foods (cereals, cookies, pizza, pasta), and soups and dressings, with new regulations further lowering the targets in 2018 and 2019.33,34 There are many benefits of a regulatory or legislative approach to sodium reduction; modeling studies show that sodium mandates with defined sodium maxima lead to better industry compliance, are more cost effective, and result in larger reductions in sodium intake than do voluntary targets.13 However, if legislation or regulation takes considerable time to enact or is difficult to change once established,35 voluntary targets may be appropriate. A voluntary approach may have a meaningful impact if there is strong and sustained central government leadership and pressure, public sector commitment to monitoring and surveillance, and a robust and active network of health organizations to hold industry accountable.
Next Steps
The FDA’s recently announced 2.5-year targets and maxima are an important step forward, but alone they will not be enough. We urge the FDA to build on the release of these targets and develop a robust system to monitor industry progress and changes in population sodium intake over time as part of a broader federal strategy on sodium reduction. The creation of a branded, up-to-date, publicly accessible nutrition database that enables the monitoring of packaged and restaurant foods will be key to ensuring industry participation and to setting future targets. To this end, our findings suggest the need for both monitoring and continued government action to ensure ongoing progress in sodium reduction in the food supply.
ACKNOWLEDGMENTS
Funding for the National Salt Reduction Initiative (NSRI) Database was supported in part by the Centers for Disease Control and Prevention (CDC; cooperative agreements 1U58DP002418-01, 1U58DP003689-01, 5U58DP003689-0, 5U58DP003689-03, 1U58DP005465-01). Alyssa Moran, Jiangxia Wang, and Christine Johnson Curtis were supported under contracts with the New York City Department of Health and Mental Hygiene.
An abstract of this work was accepted for a poster presentation at the American Society for Nutrition, Nutrition 2020 meeting, which was held virtually because of COVID-19.
The authors would like to thank the more than 100 members of the NSRI, who have been instrumental in demonstrating support for sodium reduction nationally over the past 10 years. This work would not be possible without the dedication of Sonia Angell, Jenifer Clapp, Sarah Niederman, Elizabeth Leonard, Elizabeth Solomon, and many New York City Department of Health and Mental Hygiene staff.
Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the CDC.
CONFLICTS OF INTEREST
A. J. Moran has received research funding from the New York City Department of Health and Mental Hygiene, Healthy Eating Research (a national program of the Robert Wood Johnson Foundation), the National Institutes of Health, the Duke–University of North Carolina Center for Behavioral Economics and Healthy Food Choice Research, and the Center for Science in the Public Interest. She has received consultancy fees from the New York City Department of Health and Mental Hygiene, the New York Academy of Medicine, and the University of Illinois, Chicago.
HUMAN PARTICIPANT PROTECTION
No protocol approval was necessary because this research did not involve human participants.
Footnotes
See also Brown et al., p. 191.
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