Little evidence of sodium reduction in food supply despite ‘encouraging’ data published by FDA

CSPI recommends more aggressive—and more closely monitored—targets to lower salt in food

In August 2024, the Food and Drug Administration said that it had “encouraging” news regarding food manufacturers’ work to reduce sodium in the food supply. The agency’s “Phase I” voluntary sodium reduction targets for industry, finalized in 2021, were making a difference, according to the agency. FDA’s preliminary assessment estimated that the sales-weighted mean sodium content decreased in 52 percent of food categories, increased in 34 percent, and stayed the same in 15 percent.

Researchers at the nonprofit Center for Science in the Public Interest in Washington observed that FDA indicated the direction of changes across food categories, but not the actual magnitude of those changes. So, with researchers at the Kaiser Permanente Bernard J. Tyson School of Medicine and the Johns Hopkins School of Medicine, CSPI re-analyzed the FDA’s publicly available data. Their findings, published today in a JAMA Viewpoint, reveal that the news about sodium reduction is a little bit less “encouraging” than the FDA let on.

Overall, the researchers found that the magnitude of change in food categories was very small, with a median change of -3 percent overall across all the food categories. But 11 food categories—primarily representing foods sold in restaurants—increased in sodium by 25 percent or more. Only seven categories of food decreased in sodium by that amount or more.

Reducing sodium in the food supply is important because excess sodium promotes high blood pressure and heart disease. In 2010, the Institute of Medicine (now the National Academy of Medicine) recommended mandatory sodium reduction targets for food. Between then and 2024, the effective date for FDA’s Phase I sodium reduction targets, the scientists estimate that as many as 1.3 million preventable deaths may have occurred.

“As important as FDA’s voluntary sodium reduction targets are, it’s hard to fairly characterize the progress that companies have made as ‘encouraging,’” said CSPI Science Director and lead author, Aviva Musicus, also on faculty at the Harvard T.H. Chan School of Public Health. “In fact, industry’s lackluster progress on sodium reduction, particularly among restaurants, points to a need for more aggressive targets, and for FDA to do more to encourage companies to achieve them.”

Besides setting more aggressive targets for Phase II, the scientists recommend that the FDA rigorously and transparently monitor and evaluate industry’s sodium reduction progress for both Phase I and II targets, including by making all underlying data available in a public database. This would allow the public to identify the worst-performing food companies, and for researchers to flag any unintended changes to the food supply, like companies adding more sugar to their foods as they reduce sodium content. And, the authors say, if the FDA’s evaluation of its Phase II sodium reduction targets finds little to no industry progress, it should consider making its targets mandatory, not voluntary, as 19 other countries have done.

“Salt is not a food additive that garners big headlines, but its overconsumption makes it the most dangerous additive in the food supply,” said CSPI President Dr. Peter G. Lurie. “If the incoming administration intends to make a dent in chronic disease, pursuing a more aggressive sodium strategy should be at the top of its to-do list. As it is, sodium—like added sugars, tobacco, and alcohol—all go unmentioned in the executive order creating a MAHA commission.”

“Spurring sodium reduction across our food supply is one of the most promising tools to mitigate cardiovascular morbidity and mortality,” the Viewpoint concludes. “We urge the FDA to fulfill its obligation to protect the health of U.S. residents by seizing this opportunity to hold food companies accountable.”

Besides Musicus, authors on the JAMA Viewpoint are Jaqueline Xu of the Kaiser Permanente School of Medicine, Dr. Joseph T. Kannarkat of the Johns Hopkins School of Medicine, and Dr. Peter G. Lurie of CSPI, a former Associate Commissioner of the FDA during the Obama administration.

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