Prevention Matters

Consumption of excessive sodium is a direct cause of hypertension, which affects nearly 1 in 3 Americans. CDC’s next Public Health Grand Rounds, entitled Sodium Reduction: Time for Choice, will be webcast live from CDC headquarters in Atlanta, Georgia on Thursday, April 21st at 1 p.m. (EDT) at www.cdc.gov/about/grand-rounds. Dr. Darwin Labarthe, Director of CDC’s Heart Disease and Stroke Prevention Division, will lead a discussion with other experts on the consequences of too much sodium in the diet and the regulatory and technological context for the use of salt in our food supply. The session will also review current sodium control efforts such as the National Salt Reduction Initiative and food procurement policies, and separate fact from fiction to support actions needed to address this very real public health burden.

Controlling the amount of sodium is not as simple as removing salt shakers from tables. Much of the sodium in food comes from processing and restaurant use. A multi-pronged strategy is needed to address the health consequences of excessive sodium. Tune in to the CDC webcast to learn the facts and options for addressing this critical issue.

"Best and Worst News for Prevention” is based on a purposive sample consisting of expert staff members who each week choose to share their opinions on the best and worst news for prevention.

BEST

Big VA Study Shows Surgery Checklist Saves Lives

Answering such basic questions from surgery checklists — and involving everyone as a team, even patients — saved lives in Veterans Affairs hospitals, according to one of the most rigorous studies of patient safety in the operating room.

Surgery deaths dropped 18 percent on average over three years in the 74 VA hospitals that used the strategy during the study. Surgery team members all created checklists and discussed them in briefings before, during and after surgery. That's a somewhat novel concept in a setting where the surgeon has traditionally called all the shots.


WORST

Americans Still Reaching for the Salt Shaker


Despite constant pleas by public health experts to hold the salt, the sodium intake of the U.S. population hasn't decreased over the past 46 years, according to a new review.

Most of us eat a lot more sodium than is recommended, says researcher Adam Bernstein, MD, ScD, a research fellow in the department of nutrition at Harvard School of Public Health in Boston.


The “Best and Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. "Best and Worst News for Prevention” is based on a purposive sample of expert staff members who each week choose to share their opinions on the best and worst news for prevention. More information is available at http://www.prevent.org/.

On Monday and Tuesday the National Forum for Heart Disease and Stroke Prevention held its 8th annual meeting in Washington DC. The meeting focused on developing the will to prevent heart disease and stroke in the public and private sectors, including drawing attention to the recently released Institute of Medicine (IOM) reports on hypertension and sodium reduction.

Dr. David Fleming, the chair of the IOM Committee on Strategies to Reduce Sodium Intake and a member of Partnership for Prevention’s National Commission on Prevention Priorities (NCPP), presented information about actions that can be taken by food manufacturers, the federal government, and public health professionals to reduce the sodium content in foods. The sodium plenary session was timely, occurring a few days after Partnership’s congressional briefing on reducing sodium consumption.

Another highlight from the meeting was a session on connecting traditional and emerging communication approaches to change behavior. Dr. Rob Gould, President and CEO of Partnership, spoke about behavior change and exciting new methods of communication. Other panelists hailed from the CDC, NIH, and Pew Research Center.

The National Forum on Heart Disease and Stroke Prevention works to provide leadership and facilitate collaboration among those committed to preventing heart disease and stroke. Partnership participated in last year’s Forum Symposium on the Health Economics of Cardiovascular Disease, and recently joined as a Forum member. Partnership’s work in cardiovascular disease prevention includes its Aspirin Task Force , a multidisciplinary group of medical professionals committed to promoting aspirin for primary prevention of heart disease and stroke, as well as projects in its priority areas of tobacco cessation and control, and poor nutrition and physical inactivity (obesity). For more information on the Forum and the Annual Meeting, please click here.

Rebecca Doigan
Program Associate
Partnership for Prevention

The Food and Drug Administration’s plans to gradually reduce the amount of salt consumed each day by Americans was named the “Best Prevention Idea of the Week,” while the rise in use of smokeless tobacco, chewing tobacco and snuff by teens in recent years was named the “Worst Prevention Idea of the Week."

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are submitted by Partnership staff as well as the general public, and are voted on by the staff. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders who are working to make evidence-based disease prevention and health promotion a national priority. More information is available at http://www.prevent.org/.

BEST

FDA poised to save lives by lowering sodium content … It’s about time!

In a page one story in the Washington Post entitled, “FDA plans to limit amount of salt allowed in processed foods for health reason," reporter Lyndsey Layton writes:

“The Food and Drug Administration is planning an unprecedented effort to gradually reduce the salt consumed each day by Americans, saying that less sodium in everything from soup to nuts would prevent thousands of deaths from hypertension and heart disease. The initiative, to be launched this year, would eventually lead to the first legal limits on the amount of salt allowed in food products.”

The FDA’s involvement is welcome news. For years public health authorities have cautioned Americans to reduce sodium consumption in order to reduce the risk of heart disease and stroke; the nation’s first and third leading causes of death.

WORST

Smokeless tobacco use rising among teens

The use of smokeless tobacco, chewing tobacco and snuff, by teens has risen in recent years, reversing a trend toward declining use of all tobacco products by teens, Terry Pechacek of the Centers for Disease Control and Prevention told a U.S. congressional panel. He said data to be released in the next few months will show an increase mainly among white and Hispanic young males. Health experts say smokeless tobacco can cause cancers of the mouth, throat, esophagus and pancreas. Pechacek said the CDC is concerned that high school students perceive smokeless tobacco to be safer than cigarettes.

Mayor Michael R. Bloomberg, Deputy Mayor for Health and Human Services Linda I. Gibbs and Health Commissioner Dr. Thomas A. Farley announced the first 16 companies to formally commit to the National Salt Reduction Initiative – a public-private partnership created to reduce Americans’ salt consumption by 20% over five years. New York City began coordinating this voluntary effort two years ago. The National Salt Reduction Initiative partnership now includes 18 national health organizations; 29 cities, states and related entities; and some of the nation’s leading food companies, including: Au Bon Pain, Boar’s Head, FreshDirect, Goya, Hain Celestial, Heinz, Kraft, LiDestri, Mars Food, McCain Foods, Red Gold, Starbucks, Subway, Unilever, Uno Chicago Grill and White Rose.

According to Dr. Robert J. Gould, Partnership’s CEO, “I commend Mayor Bloomberg and the NYC Department of Health for their leadership on this vital public health issue. Over the past 30-40 years the consumption of sodium in the diet has increased to levels that have alarmed clinicians and the public health community. 77% of the sodium in our diets come from processed and restaurant foods. The commitment and national leadership of Mars Foods and other companies to promote public health by reducing the sodium levels of their products is a positive example that other food manufacturers should quickly follow.”

Americans consume roughly twice the recommended limit of salt each day. The sodium in salt is a major contributor to high blood pressure, which in turn causes heart attack and stroke, the nation’s leading causes of preventable death.

Last week, the Institute of Medicine released a report stressing the urgent need to reduce sodium intake in the United States. The report recommends that the U.S. Food and Drug Administration use its regulatory authority to reduce salt in the nation’s food supply, but it also notes that public-private partnerships can “achieve meaningful reductions in sodium intake prior to the implementation of mandatory standards.”

On April 22, Darwin Labarthe, MD, MPH, PhD, Director of the Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention, told a briefing of the Congressional Prevention Caucus that “the current level of sodium added to the food supply—by food manufacturers, foodservice operators, and restaurants—is simply too high to be “safe” for consumers. Reducing the sodium content of processed foods is a necessary and urgent public health strategy for reducing blood pressure and preventing hypertension, heart disease, stroke, and other cardiovascular diseases. The time is now.”

William Tatum
Director of Membership
Partnership for Prevention

In a page one story in yesterday’s Washington Post entitled, “FDA plans to limit amount of salt allowed in processed foods for health reason," reporter Lyndsey Layton writes:

“The Food and Drug Administration is planning an unprecedented effort to gradually reduce the salt consumed each day by Americans, saying that less sodium in everything from soup to nuts would prevent thousands of deaths from hypertension and heart disease. The initiative, to be launched this year, would eventually lead to the first legal limits on the amount of salt allowed in food products.

The FDA’s involvement is welcome news. For years public health authorities have cautioned Americans to reduce sodium consumption in order to reduce the risk of heart disease and stroke; the nation’s first and third leading causes of death. In fact, according to the Centers for Disease Control and Prevention, 69% of adults in the United States are at “especially high risk for health problems from consuming too much sodium.” You are considered high risk if you are over 40 years of age, African American or have high blood pressure.

But following advice to reduce sodium consumption is tough work. 77 percent of sodium in our diets come from processed and restaurant foods. According to the WPost story the FDA is planning to “analyze the salt in spaghetti sauces, breads and thousands of other products” and (work) “with food manufacturers” to set limits for salt that would be “designed to gradually ratchet down sodium consumption. The changes would be calibrated so that consumers barely notice the modification.” (emphasis added)

A few hours after publication of the story, the Institute of Medicine lifted a media embargo and went public with their much anticipated report “Strategies to Reduce Sodium Intake in the United States.” The report confirms that despite multiple “voluntary efforts to reduce sodium consumption in the United States during the past 40 years, they have not succeeded.”

Much is at stake. According to the IOM, “population-wide reductions in sodium could prevent more than 100,000 deaths annually.”

The heart of the IOM recommendation is a regulatory strategy similar to the approach the Washington Post indicated the FDA was considering. They recommend “the FDA set mandatory national standards for the sodium content in foods – not banning outright the addition of salt to foods but beginning the process of reducing excess sodium in processed foods and menu items to a safer level.” The report emphasized: “It is important that the reduction in sodium content … be carried out gradually, with small reductions instituted regularly as part of a carefully monitored process.”

And good news for food gourmands. The report notes “evidence shows that a decrease in sodium can be accomplished successfully without affecting consumer enjoyment of food products IF IT IS DONE (emphasis added) in a stepwise process that systematically and gradually lowers sodium levels across the food supply.”

On Thursday, April 22,  Partnership will host a briefing (“Reducing Sodium Consumption: Is it time?") on Capitol Hill with the Congressional Prevention Caucus to hear more about the adverse health effects of excessive sodium in the diet. Caucus Co-Chair, Representative Jim Moran (D. VA) will open the briefing which will be moderated by Partnership’s President Rob Gould. The briefing will include presentations by:

• Darwin Labarthe, MD, MPH, PhD, Director, Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention
• Thomas Farley, MD, MPH, Commissioner, New York City Department of Health and Mental Hygiene
• Mark Broadhurst, Director, Corporate Affairs and State Public Policy, Mars Food US
• Suzanne Hughes, RN, MSN, Preventive Cardiovascular Nurses Association

Briefings of the Congressional Prevention Caucus are open to the public. If you are able to attend this event, please email Partnership for Prevention at meetings@prevent.org

E Ripley Forbes
Director, Government Affairs
Partnership for Prevention

The Institute of Medicine, (IOM) in a study released today, made recommendations to increase progress in hypertension reduction and control. The study titled A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension, focused on identifying “strategies that can reach large numbers of people and improve the well-being of entire communities.”

The bad news is that hypertension (high blood pressure), affects nearly one in 3 adults – 73 million people and kills one in 6 adults annually. The good news is that it can be diagnosed easily, is preventable and relatively inexpensive to treat. The challenge is to provide more clinical and population-based interventions to more people, particularly those at high risk of cardiovascular disease.

This study makes several recommendations, including two key dietary strategies – reduction of sodium intake and increase in potassium intake. Currently, 87 percent of U.S. adults consume more than the recommended daily 2.3 grams of sodium and only about 2 percent of U.S. adults meet current dietary guidelines for potassium. Clearly many partners – including state and local governments, food industry, and health and education sectors need to join forces to develop and implement effective awareness and behavior change programs.

Posted by:
Diane Canova
Vice President, Policy & Programs, Partnership for Prevention