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Nutrition by the Numbers Sodium Reduction By Monica H. San Miguel cartoonstock.com Objective Gain a holistic understanding of the challenges of sodium reduction from new product development through consumer consumption. Agenda • • • • • Sodium in the Eyes of the Consumer Why Sodium Reduction? Government Regulation. - Potential Government Regulation in light of Health Risks - Upcoming Meal Pattern Update in Schools with Sodium as a target. How are major food manufacturers responding? - What are the proactive steps major food manufacturers are taking? How to partner with food manufacturers in the effort to reduce sodium consumption - Nutrition Education. - Tips for Reducing Sodium in the kitchen. Top Health & Wellness Claims Product Label Claim Fat Claim Natural Calorie Claim Salt/Sodium Claim Preservative Free Cholesterol Free Whole Grain Sugar Claim Calcium Presence Caffeine Free Organic (UPC-Coded) Hormone/Antibiotic Free 52-Week $ Sales $44.7 Billion $20.9 Billion $17.0 Billion $15.9 Billion $11.4 Billion $10.6 Billion $10.1 Billion $9.7 Billion $9.4 Billion $5.7 Billion $4.3 Billion $2.2 Billion Source: Nielsen Label Trends, Total U.S. Food/Drug/Mass excluding Wal-Mart,52 Weeks Ending 2/23/08 Change Vs. Year Ago +12% +11% +6% +3% +4% +6% +8% +8% +3% -2% +25% +17% Change Vs. 4 Years Ago +29% +35% +27% +8% +16% +10% +31% +35% +9% -3% +142% +66% But, Doctor, I Never Use A Salt Shaker Yes, Mr. Smith. You don’t salt anything, but you do eat a lot of sodium! Source: Nutrient Essentials By: Penny Kris-Etherton, Ph.D., R.D. Department of Nutritional Sciences Pennsylvania State University A little over half of Americans are satisfied with their health status. (n=1000) 2008 6% 18% 17% 46% 14% 60% Not At All Satisfied Not Very Satisfied Neither Satisfied Nor Unsatisfied Somewhat Satisfied Extremely Satisfied How satisfied are you with your overall health status? ↑ Significant increase from year indicated ↓ Significant decrease from year indicated IFIC Foundation Food & Health Survey 2008 Total does not add to 100 percent due to rounding Health: Where consumers are and where they want to be. Where they ARE Healthy Unhealthy Where they WANT to be Source: Seeing Nutrition through the Consumer’s Eyes Shelley Goldberg, MPH, RD, Senior Director,International Food Information Council (IFIC) Foundation Nutrient Essentials: Sodium and the Healthy Plate; July 10, 2008. What’s healthy, what’s not. Unhealthy Healthy • Active • Energetic • Confident • Smiling • Good complexion • Good posture • Bright and wideeyed • Works out/is fit • Positive attitude • Well-rested Overweight vs. Source: Seeing Nutrition through the Consumer’s Eyes Shelley Goldberg, MPH, RD, Senior Director,International Food Information Council (IFIC) Foundation Nutrient Essentials: Sodium and the Healthy Plate; July 10, 2008. Unkempt Smokes/drinks/does drugs Walks slowly Dejected, holds head down Bundle of nerves Lays on couch Out of breath Dull skin Depressed/negative WELLNESS Source: Iconoculture, 2008. Types of foods and ingredients consumers report avoiding. 50% 54% Sugar/carbs 33% 38% Fats/oils/cholesterol 28% Animal products 21% 12% 15% Salt/sodium Snack foods/fast foods/soda Artificial/additives Spices Processed/refined foods Biotech 16% 14% 2% 4% 2006 2007 1% 2% 0% 2% 0% 0% Other 11% 11% [IF AVOIDED FOODS] What foods or ingredients have you avoided? [OPEN END] Source: Seeing Nutrition through the Consumer’s Eyes Shelley Goldberg, MPH, RD, Senior Director,International Food Information Council (IFIC) Foundation;Nutrient Essentials: Sodium and the Healthy Plate; July 10, 2008. International Food Information Council, 2007 = Statistically significant Sodium & Health: Consumer • • • • • 52% of consumers say they're keeping an eye on sodium in their diet.* About in one in five (22%) cuts back on the salt added to food but pays far more attention to sodium levels in prepared foods and beverages.* Another 18% consider low-sodium foods and beverages “one of the three most important components of a healthy diet.”* One-quarter (26%) of consumers say they check labels for sodium and may be influenced by what they see but do not follow a set plan to monitor sodium in their diet.* The Smart Choices Program was driven by consumer demand for a single, trusted and reliable front-of-pack nutrition labeling program that food manufacturers and retailers (≤ 480 mg per serving). It is currently on hold. Source: Mintel, 2009 Informed Choices – Learn from various sources – Want detailed information on menu items – Impacts food selection Source: Technomic, Generational Consumer Trend Report (2008) Nutrition Facts Terms • "very low sodium" (35 mg or less per serving) • "low in sodium" (140 mg or less per serving) • "reduced sodium" (at least 25 percent less sodium when compared with a similar food). Consumers See New York Nutritional Disclosure Law as a Positive “Do you consider this a positive move?”* No 14% “Do you read nutritional information on menus?”** No 16% Yes 86% *Base: New York Consumers aware of the calorie disclosure ordinance **Base: New York Consumers visiting a restaurant with posted nutritionals Source: Technomic, Generational Consumer Trend Report (2008) Yes 84% Consumers Want Nutritional Disclosure Fat content should also be posted more prominently 40% 46% 86% Sodium content data should also be posted more prominently 40% 45% 85% Nutritional information on menus will have a positive impact on overall health and nutrition 42% 42% 84% Nutritional information on menus is helpful when I am making ordering decisions 36% 39% I know how many calories I need a day I do not want to see prominent nutrition information on menus or menu boards Somewhat Agree Base: 299 New York Consumers 4-point scale: Completely Agree (4) – Completely Disagree (1) Source: Technomic, Generational Consumer Trend Report (2008 ) 20% 11% 31% Completely Agree 47% 35% 83% 74% Nutrition Disclosure • • • • According a February 2009 Technomic survey: New York City restaurants with 15 or more units have had mandated calorie disclosure since the city passed a regulation last July. The Technomic survey revealed that 82 % of the city's restaurant diners said calorie disclosure affects what they order, while 60 % said it affects what restaurant they visit. 81% of consumers thought restaurants have a responsibility to respond more aggressively to nutritional concerns by offering more low-calorie and small-portion options. Research also showed a high level of consumer support for mandated disclosure of fat and sodium content in restaurant foods. New York City is not alone in its menu nutrition information legislation. Philadelphia and Washington's King County have passed nutrition information laws and several state legislatures have pending labeling laws, among them Indiana and Massachusetts. In King County, which includes the greater Seattle area, disclosure of calories, sodium, saturated fat and carbohydrates is required. California was the first to pass statewide menu labeling legislation for the disclosure of caloric information in the form of bill 1420 last fall that requires that California restaurants with 20 units or more provide nutritional information to consumers either on a menu or on a menu board. That bill will affect 100 Darden Restaurant units, which includes the Red Lobster and Olive Garden brands. The company has implemented calorie disclosure in seven restaurants in New York City and six in King County. But Taste is King • • • • Taste and sensory factors: “Salty” is known as one of the five basic tastes, along with sweet, sour, bitter, and umami. Scientists have attempted to mimic this taste with salt substitutes with limited success. While lower sodium food products generally taste less salty, they often require the use of other ingredients to add or enhance flavor. There is evidence that the level of sodium preference is learned. In fact, early experiences with low or high sodium diets may have a longterm impact on an individual’s preferred sodium level. Studies have demonstrated that a gradual reduction in sodium intake over 8 to 12 weeks can decrease preference for salty foods and increase acceptance of foods with less sodium. [Bertino et al., 1982; Mattes, 1997].* http://www.ific.org/publications/reviews/sodiumir.cfm Why Sodium Reduction? • The prevalence of high blood pressure in children is rising, increasing their adult risk of heart disease and stroke. • The average American Adult consumes 2,900 mg to 4,300 mg per day (American Heart Association). Sodium is a learned taste. Gradually taking sodium out of foods can “un-learn” the appeal of salt. Great to do at the beginning of the school year, after the summer away. The cost of excess sodium Lower Sodium Could Mean Lower Health-Care Costs If Americans consumed the recommended daily maximum of 2,300 milligrams of sodium a day, the country could trim almost $18 billion in health-care costs and reduce hypertension cases by 11 million, according to a Rand Corporation study. Reducing sodium even further, to 1,500 milligrams a day, could decrease health-care costs by $26 billion. Average Sodium Consumption (milligrams per day) 3,400* 2,300 1,700 1,500 1,200 Direct Health-Care Costs Saved (in $ billions) Hypertension Cases Reduced (in millions) $17.8 $23.8 $26.2 $28.3 11.1 14.9 16.4 17.7 *Average sodium intake of representative sample of adults. Source: "Potential Societal Savings from Reduced Sodium Consumption in the U.S. Adult Population," 2005, Rand Corp. Forms of Sodium • 90% of sodium consumed as sodium chloride (salt) • Other forms: – sodium bicarbonate – sodium in processed foods, such as sodium benzoate and sodium phosphate Source: The Health Effects of Reducing Sodium and Improving Overall Diet By Lawrence J Appel, MD, MPH, Professor of Medicine, Epidemiology and International Health (Human Nutrition); July 9, 2008. Sources of Sodium in the Diet Added at table 6% Added during cooking 5% Inherent in foods 12% Food Processing 77% Source: Nutrient Essentials By: Penny Kris-Etherton, Ph.D., R.D. Department of Nutritional Sciences Pennsylvania State University, July 2008 Primary effect of sodium that drives policy: Increased blood pressure (and subsequent blood pressure related CVD renal disease). Magnitude of the Blood Pressure Problem • 62% of strokes and 49% of CHD events attributed to elevated BP* • 26% of adults worldwide (971 million) have hypertension** *WHO, World Health Report 2002: Reducing Risks, Promoting Healthy Life, **Kearney Lancet 2005;305:217, Source: The Health Effects of Reducing Sodium and Improving Overall Diet By Lawrence J Appel, MD, MPH, Professor of Medicine, Epidemiology and International Health (Human Nutrition); July 9, 2008. Factors Associated with Increased Blood Pressure Response to Salt • Fixed factors – – – – Middle and older-aged persons African-Americans Genetic Factors Individuals with: • Hypertension • Diabetes • Chronic Renal Insufficiency • Modifiable – Low potassium intake – Poor quality diet Source: The Health Effects of Reducing Sodium and Improving Overall Diet By Lawrence J Appel, MD, MPH, Professor of Medicine, Epidemiology and International Health (Human Nutrition); July 9, 2008. Dietary Recommendation • • • According to the American Heart Association, the current Dietary Guidelines recommendation of less than 2,300mg of sodium per day is too high and it should be changed to no more than 1,500mg of sodium per day.* In recent comments to the Food and Drug Administration and the Institute of Medicine, AHA recommended that the daily value for sodium be lowered to 1,500mg by 2020 with an intermediate goal of 2,000mg by 2013. This two-step phase down should provide manufacturers with time to reformulate products and identify acceptable sodium substitutes, as well as allow consumers to adapt their taste sensitivities to the lower sodium content in foods. With processed foods accounting for 77% of all sodium consumed, it will require the cooperation of food manufacturers and restaurants to reduce the sodium content of the foods they make available to the public. AHA would like to see food manufacturers and restaurants reduce the salt added to foods by 50% over the next 10 years. Source: American Heart Association Dietary Guidelines 2010, January 23, 2009. School Meal Pattern • Focus on Nutrient Density: colorful nutrient dense vegetables. • These Food Groups For Which Intakes were found inadequate by Institutes of Medicine Phase I Study. • These food groups likely to be targeted for increases/new median levels. • Proposed Method by Institutes of Medicine is to also follow MyPyramid Guidelines. New or stricter guidelines are likely to be included as part of the updated School Meal Pattern. These nutrients were found as excessive intakes in the Institutes of Medicine Phase I Study: 1. 2. 3. 4. Source: National Academy of Sciences. Sodium Saturated Fat Total Fat Cholesterol Potential Government Regulation • • • The Center for Science in the Public Interest has called for increased government regulation of sodium in food products since the 1970s (the U.S. Food & Drug Administration currently regulates salt as a “Generally Recognized As Safe” substance). Food manufacturers & Restaurant Chains are willing and have been working towards sodium reduction vouluntarily. Mintel's Global New Products Database charts a 115% increase between 2005 and 2008 in the number of food products making low-, no- or reduced-sodium claims.* *http://www.ific.org/publications/reviews/sodiumir.cfm NRA Sodium & The Healthy Plate Conference 2008 National Restaurant Association Conference with focus on Sodium Reduction and Better For You: Nestle, McDonald’s, Burger King, McCain Foods, ConAgra, Sodexo, Compass, Denny’s, Chick-fil-A, Arby’s, Kraft, General Mills, Subway, Birds Eye Foods, Campbell Soup, KFC, IHOP, Tyson, Chipotle, Chicago UNO, ARAMARK attended. Consensus: consumers prefer natural foods to commercial/processed foods. All Manufacturers/Retailers/Restaurant Chains (except for Campbell Soup) that presented are following a “stealth approach” gradually decreasing levels of sodium without telling the consumer. Nestle FS has found that cleaner labels/Natural is more important than price and “Low sodium,” so they traded off to “Reduced Sodium.” Source: www.restaurant.org/events/nutrition What does salt do? • Flavor – Unique, Impact, Enhancement, Metallic • Mouthfeel • Reduces Water Activity • Texture Source: Technical Challenges in Sodium Reduction – A Product Development Perspective By Harlan Meinwald, Nestlé Professional, Culinary Product Development Support; July 10, 2008. Developing a Reduced Sodium Strategy: Manufacturer’s POV Trade-offs •Sodium – How low? •Match / Preference / Acceptance •Cost •Other sensory / performance aspects •Other label declarations •Other technical aspects •Handling Source: Technical Challenges in Sodium Reduction – A Product Development Perspective By Harlan Meinwald, Nestlé Professional, Culinary Product Development Support; July 10, 2008. Case Study #1 Marketing wants to reduce sodium content of a signature frozen entrée by 200 mg. PD explores alternative concepts and recipes. Mktg decides to keep current concept. PD reduces salt in current recipe (no other changes). Reformulated product passes preference panel. Current Status: Preparing to launch. Source: Technical Challenges in Sodium Reduction – A Product Development Perspective By Harlan Meinwald, Nestlé Professional, Culinary Product Development Support; July 10, 2008. Case Study #2 Customer of frozen entrees wants to reduce sodium content from 1100 mg per serving to 750 mg. They plan to do this in 3 stages, ~10% at a time. Current Status: All products have samples pending at 10% sodium reduction. Customer is deciding whether to do match, preference, or acceptability testing. Source: Technical Challenges in Sodium Reduction – A Product Development Perspective By Harlan Meinwald, Nestlé Professional, Culinary Product Development Support; July 10, 2008. Case Study #3 Customer of dry soups wants to reduce sodium content 15%, matching flavor as closely as possible. PD develops match using potassium chloride, yeast extract, and a natural flavor. Current Status: Customer implementing reformulation. Source: Technical Challenges in Sodium Reduction – A Product Development Perspective By Harlan Meinwald, Nestlé Professional, Culinary Product Development Support; July 10, 2008. Case Study #4 Marketing wants to launch “natural” bases which are low sodium, same price, same handling, and same flavor profile as current bases. PD works with several flavor companies and internal resources to develop product and demonstrate trade-offs. Current Status: Launching “natural” bases which are reduced sodium (25%), slightly more expensive, same handling, and a more home-made flavor profile versus current bases. Source: Technical Challenges in Sodium Reduction – A Product Development Perspective By Harlan Meinwald, Nestlé Professional, Culinary Product Development Support; July 10, 2008. Case Study # 5 Part 1: Customer requested 25% sodium reduction and flavor match of a concentrate. Product passed blind panel, but customer felt it was not close enough in finished recipes and had some (undefined) off notes. Part 2: Customer requested 75% sodium reduction without flavor match. Removing the salt changed the handling from “Keep Refrigerated” to "Keep Frozen“, which did not work as well in their kitchens. Current Status: On Hold. Customer developing nutrition strategy. Will then define limits and priorities for menu items. Source: Technical Challenges in Sodium Reduction – A Product Development Perspective By Harlan Meinwald, Nestlé Professional, Culinary Product Development Support; July 10, 2008. Case Study #6 Customer purchasing and operations initiated project to improve handling in the kitchen without raising cost or changing the product. Chef also requested 15% sodium reduction, smaller carbon footprint, and a more “natural” ingredient statement. Current Status: Development in process. Source: Technical Challenges in Sodium Reduction – A Product Development Perspective By Harlan Meinwald, Nestlé Professional, Culinary Product Development Support; July 10, 2008. Portions – Easy Way to Control, not just fat, but Sodium • Proactive approach to reduce sodium. • Smaller portions of higher-sodium foods (lunch meats, hot dogs, bacon and pickles). Source: TeamNutritionUSA.gov Reducing Sodium – Before Cooking • • • • • • • • • Offer high-sodium foods less often – pizza, chicken nuggets, and hot dogs as examples. Use grilled chicken breast instead of luncheon meat, bacon, sausage, or ham. Modify recipes that use high-sodium ingredients such as cheese sauces, canned foods, tomato sauce, paste, Use lower sodium versions or use less. Remove salt from recipes whenever possible. Serve more fresh foods. Ask vendors for lower sodium versions of popular foods. Serve salted snacks such as pretzels in smaller amounts. Serve smaller amounts of condiments such as catsup, relish, and salad dressing. Offer salt-free seasonings as an alternative. Reducing Sodium – During Cooking • • • • • • • • • Use fresh or dried herbs, spices, lemon or orange zest, or fruit juices to jazz up the flavors in foods without adding sodium! Add lemon rind or juice, in place of salt, to water that is used to boil spaghetti. pasta, rice, beans, and hot cereals. Add a little dry mustard or a dash of Tabasco sauce to egg dishes instead of salt. Prepare and heat vegetables without adding salt or butter. Avoid using baking soda to retain the bright color of green vegetables. Instead, cook for the appropriate length of time. Prepare soups, sauces from scratch with unsalted, defatted stocks. Prepare food from scratch as is feasible to control added sodium. Purchase herbs and seasoning powders, rather than salts (e.g., onion powder instead of onion salt). Make your own herb blends, vinegar, and spicy seasoning mixes. Rinse canned vegetables in water before cooking. Reduced Sodium – On The Table • • • Salt Shakers – off the table. Substitute for a squeeze of lemon or lime juice, a splash of vinegar, or a shake of a salt-free seasoning blend. Use herbs and spices in place of salt in recipes for casseroles, soups, stews, chili and pasta sauces. Condiments…if used, use portion packs, control amounts. Education idea for education dining facilities– charge for salt packets (5 cents). Tell students why. Sodium Reduction: Partnership • Sodium Reduction is a complex problem. • Current dietary guidance targets sodium reduction, and provides strategies for implementation. • Given the widespread distribution of sodium in the food supply, there are many targets. • The restaurant and food industry can play a key role in decreasing sodium and helping consumers adhere to dietary recommendations • The solution is partnerships between food manufacturers and operators. • Nutrition Education plays a key role. • Integrate reduced sodium products with sodium reduction in the kitchen. Questions?? Sources • • • • • • • • http://www.teamnutrition.usda.gov/Resources/roadtosuccess.html http://www.teamnutrition.usda.gov/Resources/DGfactsheet_transfat.pdf www.MyPyramid.gov www.cfsan.fda.gov/~dms/transfat.html#whatis www.cnpp.usda.gov/DietaryGuidelines.htm www.teamnutrition.usda.gov/HealthierUS/index.html http://www.scribd.com/doc/1428575/USDA-menuplanner-chapter1 http://dpi.wi.gov/fns/doc/factsheet_sodium.doc Appendix AHA Diet and Lifestyle Goals for Cardiovascular Disease Risk Reduction • Consume an overall healthy diet • Aim for healthy body weight • Aim for recommended levels of LDL-C, HDL-C and triglycerides • Aim for normal blood pressure • Aim for normal blood glucose level • Be physically active • Avoid use of and exposure to tobacco products Source: Nutrient Essentials By: Penny Kris-Etherton, Ph.D., R.D. Department of Nutritional Sciences Pennsylvania State University Lichtenstein et al., Circulation, 114, 82-96, 2006 AHA Diet and Lifestyle Recommendations for Cardiovascular Disease Risk Reduction • • • • • Balance calorie intake and activity to achieve a healthy weight Consume diet rich in fruits & vegetables Choose whole-grain, high-fiber foods Consume fish, especially oily fish, 2X per week Limit intake of saturated fat to <7% of calories, trans fat to <1% of calories and cholesterol to < 300 mg per day by: – Choosing lean meats and vegetable alternatives – Selecting fat-free, 1% or low-fat dairy products – Minimizing intake of partially hydrogenated fats • • • • Minimize intake of added sugars Choose and prepare foods with little or no added salt If you consume alcohol, do so in moderation When you eat food outside the home, follow the AHA Recommendations Lichtenstein et al., Circulation, 114, 82-96, 2006 Source: Nutrient Essentials By: Penny Kris-Etherton, Ph.D., R.D. Department of Nutritional Sciences Pennsylvania State University High-priority Recommendations to Facilitate Adoption of AHA Diet and Lifestyle Recommendations • Groups included: Health Practitioners, Restaurants, Food Industry, Schools, Local Government • Specific Recommendations – Restaurants • Display calorie content or make information easily accessible • Reduce portion sizes • Reformulate products to reduce calories, sodium, saturated and trans fat • Provide more vegetable options, and prepare them with minimal added calories and salt • Provide more fruit options, with minimal added sugar • Develop creative marketing approaches for fruits & vegetables • Allow healthy substitutions • Provide whole-grain options Adapted from Lichtenstein et al., Circulation, 114, 82-96, 2006 Source: Nutrient Essentials By: Penny Kris-Etherton, Ph.D., R.D. Department of Nutritional Sciences Pennsylvania State University High-priority Recommendations to Facilitate Adoption of AHA Diet and Lifestyle Recommendations • Groups included: Health Practitioners, Restaurants, Food Industry, Schools, Local Government • Specific Recommendations – Food Industry • Reduce salt and sugar content of processed foods • Replace saturated and trans fat in prepared foods with lowsaturated fat oils • Increase proportion of whole grain foods available • Package foods in smaller portion sizes • Develop packaging that allows more stability, preservation and palatability of fresh fruits & vegetables without added sodium Adapted from Lichtenstein et al., Circulation, 114, 82-96, 2006 Practical Tips to Implement AHA Diet and Lifestyle Recommendations (Sodium Related) • Food choices and preparation – Use nutrition facts panel and ingredients list to choose food purchases • Eat fresh, frozen and canned vegetables and fruits without high-calorie sauces, added salt and sugars • Reduce salt intake by: – Comparing sodium content of products and choosing ones with less salt – Choosing reduced sodium versions or foods, including cereals and baked goods – Limiting condiments (eg. soy sauce, ketchup) • Limit processed meat intake, especially those high in saturated fat and sodium Lichtenstein et al., Circulation, 114, 82-96, 2006 Source: Nutrient Essentials By: Penny Kris-Etherton, Ph.D., R.D. Department of Nutritional Sciences Pennsylvania State University What is a "Healthy Diet"? The Dietary Guidelines describe a healthy diet as one that •Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products; •Includes lean meats, poultry, fish, beans, eggs, and nuts; and •Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars. Source: Nutrient Essentials By: Penny Kris-Etherton, Ph.D., R.D. Department of Nutritional Sciences Pennsylvania State University DASH PYRAMID Low-Sodium Cookbooks Source: Nutrient Essentials By: Penny Kris-Etherton, Ph.D., R.D. Department of Nutritional Sciences Pennsylvania State University Organizations and Countries Recommending Major Reductions in Sodium Organizations Countries National Research Council1 Finland1 National Institutes of Health1 United Kingdom3 National HBP Education Program CC1 Australia1 Joint National Committee 71 Ireland U.S. Department of Health and Human Services1 New Zealand U.S. Department of Agriculture1 National Academy of Sciences American Medical Association3 American Heart Association1 American Public Health Association3 Center for Science in the Public Interest3 World Health Organization4 Source: The Health Effects of Reducing Sodium and Improving Overall Diet World Hypertension League By Lawrence J Appel, MD, MPH, Professor of Medicine, Epidemiology and International Health (Human Nutrition); July 9, 2008. 1 < 2300 mg/day; 2 < 2300 mg day under age 50; < 1500 mg/day for 50-70, hypertensives, and blacks; < 1200 mg/day for age 70 and higher; 3 Minimum 50% reduction in processed and restaurant foods; 4 < 2000 mg/day