CDC Telebriefing: New Vital Signs Report What can be done to help children eat less sodium?

OPERATOR:  Welcome, if you would like to ask a question, please press star one on your touchtone phone.  Today's call is being recorded.  If you have any objections, you may disconnect at this time.  I would like to turn the meeting over to Ms. Karen Hunter.  Thank you.  You may begin. 

KAREN HUNTER: Thanks, Lisa.  Thanks for joining us for today's vital signs report on sodium intake among school-age children.  We'll be hearing from Dr. Ileana Arias, the CDC principal director.  Her name is spelled I-L-E-A-N-A, and last name A-R-I-A-S. You'll also be hearing from Kevin Concannon, who is the USDA undersecretary for food, nutrition and consumer services. And his name is spelled K-E-V-I-N and last name C-O-N-C-A-N-N-O-N. We'll also be joined by two of the authors of the vital signs, Molly Cogswell and Janelle Gunn, Who are with the CDC’s Division of Heart Disease and Stroke. Molly name is spelled M-O-L-L-Y and last name spelled C-O-G-S-W-E-L-L.  Janelle name is spelled J-A-N-E-L-L-E and last name spelled G-U-N-N. They will be available to answer questions after we hear opening remarks.  Now I’d like to turn it over to Dr. Ileana Arias. 

ILEANA ARIAS:  Good afternoon and thank you to everyone, for joining us today to discuss the vital signs report which is a special publication that highlights critical public health issues facing our nation.  In our latest report we look at how much sodium children are eating and the most common foods that contribute to their sodium intake.  It's an important topic because one in six children already has raised blood pressure which can result in high blood pressure in adulthood, and as we know are a major cause of heart disease and stroke.  This is incredibly concerning to us.  Using the most recent national data, our report reveals that more than 90 percent of school-age children nationwide eat too much sodium.  The 2010 dietary guidelines for Americans recommend that children eat less than 2,300 milligrams per day total.  However, we find that children six to 18 years of age eat an average of about 3,300 milligrams per day, meaning that many of our kids are on a fast track to an unhealthy diet.  The statistics are more dramatic when we focus on just teens who are consuming about 3,700 milligrams of sodium per day.  When we mention these data, we anticipate that parents are going to now very quickly move to limit the salt shakers on the table and the salt that is put into food as they prepare their meals.  However, it's important to recognize that our report reveals that children and teens are eating too much sodium before salt is added at the table or in the kitchen, and that is because most sodium is already in food before it is bought or ordered.  And that holds true whether that food is from restaurants, school cafeterias or the ready-to-eat packaged food from the grocery store.  Approximately 65 percent of sodium that our children are consuming comes from store foods, 13 percent from fast food and pizza, and 9 percent from school cafeteria foods.  The report shows that ten types of food alone make up 43 percent of youth sodium intake nationwide.  Pizza, bread and rolls, lunch meats like deli ham or turkey, snack foods like chips, cheeseburgers and sandwiches, cheese, chicken patties or tenders, pasta dishes, Mexican mix dishes and soups comprise that top ten list.  Some of these foods may not taste salty but they are top contributors because they do have significant sodium content, and children eat a lot of them.  A poor diet in childhood can lay the foundation for future health problems, and the fact that young kids and teens are consuming so much sodium these days and adopting increasingly bad dietary habits is certainly a cause for concern.  Additionally, we know that research shows that the taste for salt is established through diet at a young age, so not only are our children eating too much sodium, they're establishing a high threshold or taste for salt beyond childhood.  So what can we do to help reduce the amount of sodium that children are consuming every day?  It will take a collective effort, parents and caregivers, schools, communities and places that sell, make or serve food to really make a difference and ensure healthier options.  For example, parents can model and create habits for healthy eating by choosing a diet rich in fruits and vegetables without added sodium.  We encourage parents to check nutrition labels on products and choose the lowest sodium option.  We encourage them to request restaurant nutrition information and also using low sodium or no salt added ingredients in meals and relate salt at home with spices, herbs or citrus for flavors.  By paying attention to nutrition labels you can reduce the amount of sodium you eat per day.  For example, eating lower sodium bread can save you 85 milligrams of sodium.  Leaving deli cheese, choosing low sodium chips and drinking water instead of a sports drink can slash approximately 490 milligrams of sodium.  It clear that parents can do something oh how much sodium children eat, they need help.  We, they, need food manufacturers and restaurants to support efforts to gradually lower sodium over time.  Fortunately, some food companies have already taken that step.  For example, Darden restaurants, owner of restaurants such as Bahama Breeze and Olive Garden have committed to reducing sodium by 20 percent over ten years and Taco Bell has reduced sodium by 20 percent.  And Food Giant ConAgra recently announced that they have already reduced sodium across their portfolio by 20 percent.  CDC has already been doing its part to reduce sodium intake by promoting local, state, and national proven actions, as well as enhancing the monitoring of sodium intake and changes in the food supply. Included in these efforts is a development and promotion of Million Heart, a national initiative focused on preventing one million heart attacks and strokes by 2017.  We're also working with schools and school districts as they  think about their purchasing policies and standards.  They can reduce sodium in the foods they prepare in their cafeterias and put healthier alternatives in vending machines in schools and school stores.  On that note, I’d like to turn it over to Kevin Concannon, undersecretary for food, nutrition and consumer services in the U.S. department of agriculture.  Kevin? 

KEVIN CONCANNON:  thank you very much, Dr.  Arias.  I'm pleased to be here on behalf of the USDA to comment on this report.  This report underscores the importance of USDA's school meals sodium standards, increasing the availability of lower sodium food products in schools and other parts of the food marketplace, together building healthier eating habits among our children.  Although hypertension, heart disease and stroke are more common among adults, the origins often begin in childhood.  Children with higher blood pressure are much more likely to develop hypertension as adults.  CDC's analysis suggests that children who ate school meals consumed less sodium.  And a study released just yesterday by the Pugh Charitable Trust found that the majority of parents across the country of all political stripes support limiting salt in school meals.  At the USDA we're working to make the school environment an important contributor to the effort to reduce children's sodium consumption.  New national nutrition standards are projected to reduce the sodium content of school meals by approximately 25 to 50 percent.  Based on this analysis, sodium intake among U.S. school-age children could be reduced across a year by an average of about 75 to 150 milligrams per day or about 220 to 440 milligrams on the days that children consume school meals, if there's no replacement from other sources.  We provide foods to school that the USDA directly purchases and they're referred to as USDA foods.  They're provided to schools as part of their school meals, and we have been reducing sodium as a major emphasis in USDA foods reformulation efforts.  We now offer a variety of no salt added, lower sodium options to help schools prepare healthier meals.  Two-thirds of the products offered through the USDA foods now to schools have no salt added in the formulations.  The remainder of USDA foods are ten percent low sodium, 11 percent that require lower sodium formulations and the remaining 12 percent that use standard industry specifications.  Schools using bulk USDA foods for processing should define sodium specifications to ensure that they receive products with sodium levels that meet their needs.  Industry is also responding to the demand created by new nutrition standards with lower sodium versions of many popular foods. Firms are investigating solutions to lowering the sodium content of foods while maintaining the nutrition standards of taste and flavor profiles.  Currently these applied approaches are resulting in sodium reductions of between 20 and 30 percent in the foods such as breads, sauces, soups and canned vegetables.  In addition, industry is now providing materials and resources on reducing sodium in school meals by modifying the recipes that use high sodium ingredients.  School meals have the potential of making an impact on sodium intake among children, but much more work remains in lowering the overall sodium content of the food supply, including foods children eat outside of school.  Dietary guidelines for all Americans recommend that we reduce our daily sodium intake to less than 2,300 milligrams per day and for those populations that are at higher risk for sodium-related illness or conditions, it's recommended to reduce to 1,500 milligrams.  Those same guidelines provide a number of strategies for consumers to use in reducing sodium intake including using the nutrition fact labels when purchasing canned foods to select those labeled as reduced sodium. Additionally, the guidelines encourage increase potassium intake which can block the adverse effect  of sodium on blood pressure. I also might mention that this is the first year across America -- and i was in a school up in Vermont yesterday where, for the first time, all of the foods sold in the school environment -- and these are nearly 100,000 American schools -- are now subject to limitations on sodium amounts in snacks, a la carte meals, whatever foods are sold in the school.  We believe that that's going to make a systemic and environmental change that helps all 50 million American school children.  Back to you, Dr. Arias. 

ILEANA ARIAS:  Thank you.  The bottom line is that the pressure is on to keep blood pressure down.  The latest vital signs shows that children and teens nationwide are eating too much sodium, and that intake, unfortunately, increases as they get older.  Heart disease, stroke and other cardiovascular diseases kill more than 800,000 Americans each year and contribute an estimated $315 billion a year in healthcare costs and lost productivity.  More than 40 percent of the sodium comes from just ten types of food among kids.  We believe that eating fresh foods and gradual voluntary reductions in sodium of packaged and ready-to-eat foods would save billions of dollars and tens of thousands of lives.  It's going to take all of us working together to reduce sodium and provide a healthier future for our children.  The pressure is on to prioritize the reduction of sodium in our children's diets to make the next generation a healthier one.  We know that eating habits begin in childhood, so the time to act is now.  So thank you for your time today.  We'll be more than happy to answer your questions at this time. 

KAREN HUNTER:  Thank you, Dr. Arias.  Lisa, I think we're ready to start taking questions. 

OPERATOR: At this time if you would like to ask a question, please press star one on your touchtone phone. You will be announced prior to asking your question. To withdraw your request, press star two. Once again, that's star one for questions. At this time I'm showing that there are no questions. 

KAREN HUNTER: Okay, well, that's going to wrap up the telebriefing. There will be a transcript available later on this afternoon on CDC's press room site. If you have follow-up questions or need additional information, please contact CDC's press office at media@CDC.gov or 404-639-3286. 

OPERATOR: Excuse me, two questions have come up. Would you like to take those? 

KAREN HUNTER: Sure would. 

OPERATOR:  Our first question comes from Allison Aubrey with NPR. Thank you, your line is open. 

ALLISON AUBREY: Hi, I was just looking on your site for the list of foods -- you mentioned about 40 percent of the stuff kids consume come from ten foods and I know at the beginning is when I called in and you were sort of naming a list of foods. I'm looking for that in the report. Maybe I just haven't found it yet.  Do you mind just ticking those off? 

ILIANA ARIAS: Sure. This is Iliana Arias. We have it in the report and also on the fact sheet on our website. I'll go ahead and go through those. Pizza, bread and rolls, lunch meat, snack foods, cheeseburgers and sandwiches, cheese, chicken patties and tenders, pasta dishes, mexican mix dishes and soups. 

ALLISON AUBREY: Got it. I know that sodium restrictions are now in place in schools as part of the new dietary guidelines or nutrition guidelines for schools, but I know pizza is a big issue at school and there are two huge companies that supply a lot of the pizza to schools around the country.  Do you know if pizza makers have moved to reduce sodium for the kinds of pizza sold in school cafeterias? 

KEVIN CONCANNON: Yes, they have. We have seen the major food supplier companies that provide meals to schools have been reformulating to meet the dietary guidelines. That is really why I am so positive and excited about the school meal standards because they do represent a systematic way of educating and supporting kids to healthier eating. I was in a school yesterday in Vermont where they weren't serving pizza but they were serving pastas that were made with whole grains. I watched the kids consume them and enjoy them and talked to the folks who prepare the foods and said no problem. They have been working on this, gradually adjusting, in effect, or educating the palate of kids. So I know kids, when introduced to healthier foods, can get used to them, enjoy them, and it can make a difference over the life course. 

ALLISON AUBREY: Thank you. 

KAREN HUNTER: Next question, please, Lisa. 

OPERATOR: Our next question comes from Mike Stobbe with The Associated Press. 

MIKE STOBBE:  Hi, thanks for taking the question. Can you -- is there a simple way to convert milligrams so people can have a better conceptualization of 2,300 milligrams of sodium? I know you said sodium and not salt but is that, what, two tablespoons and 3,300 is -- can you help us so we can visualize what the quantity is? 

JANELLE GUNN: This is Janelle Gunn from CDC. So 2,300 milligrams is about a teaspoon of salt, but you raise a challenge that we face in trying to help Americans lower sodium in that it automatically makes people think of the salt shaker rather than the salt already in their foods.  Sometimes you might think of it as the difference of choosing one can of soup over another can of soup or making different sandwich choices. You can easily save 600 milligrams in a sandwich. 

MIKE STOBBE: 2,300 is roughly a teaspoon of salt.  What's 3,300?  About one and a half? 

JANELLE GUNN: Yes, it's about one and a half. 

MIKE STOBBE: Thank you. 

OPERATOR:  Just as a reminder, if you have a question, please press star one.  Our next question comes from Mandy Oaklander with Time Magazine. 

MANDY OAKLANDER: Hi. I know that concerns about sodium and salt, there is some evidence that it's a little bit overblown. What's your response to that?  There's been a lot of back and forth. 

JANELLE GUNN: This is Janelle Gunn from CDC. CDC and other government agencies as well, we continue to evaluate the evidence and importantly we consider the totality of the evidence. A vast majority of scientific research confirms that when sodium is reduced, so does blood pressure which are leading causes of death in the U.S. Hypertension is alarming in the U.S. One in three adults have high blood pressure, and only half of those have it under control.  Even among the youth population we find one in six already has raised blood pressure. These are levels higher than we want to see for their age and gender. 

KAREN HUNTER: Next question, please? 

OPERATOR:  Our next question comes from Tom Corwin with The Augusta Chronicle.

TOM CORWIN: Hi, thanks for taking my question. We're looking at a study that was published in pediatrics earlier this year that looked at adolescents and also a very high consumption of sodium, and they found that independent of calories, that there was an association with higher weight, with greater obesity, and also inflammation factors like tumor necrosis factor alpha. I know you're talking about blood pressure, but are there correlate health measures that we should be concerned about with high sodium? 

JANELLE GUNN: That's a good question. CDC also had a report in 2012 that looked at sodium intake and obesity and we found a synergistic effect. We see it in adults as well. A couple things to keep in mind, blood pressure is the largest impact, but I think people often don't consider all the ways that blood pressure impacts our  health, more than just heart disease and stroke. 

TOM CORWIN: I'm sorry, who was speaking? 

JANELLE GUNN:  I'm sorry. This is Janelle Gunn for CDC. 

TOM CORWIN: Thank you. 

KAREN HUNTER: Next question, please, lisa. 

OPERATOR: At this time there are no further questions. 

KAREN HUNTER: We have just a few more seconds for somebody to jump in if they want before I wrap it up. 

OPERATOR: At this time I'm still showing no questions. 

ILIANA ARIAS: Hearing no more questions, I think we'll wrap up the telebriefing.  Thank you all for joining us today. We are all struggling, as was mentioned, how it is that we can message this for the best impact that we can have. Hypertension is a complex issue. There are a number of variables that have been shown to influence anybody's current or future levels of hypertension. However, we are talking about a variable that is easily controlled, that is directly impactful on hypertension among kids certainly and that sets up a trajectory -- projection for negative outcomes in adulthood as well. So we are hopeful that parents take advantage of the control that they do have and exert that control over the health of their children, not just for when they are children, but also for when they grow into adulthood as well. Thank you very much. We'll sign off now. 

KAREN HUNTER:  That was Dr. Arias. And again, there will be a transcript of this telebriefing available later on this afternoon on CDC's press room site. Again, if you have additional questions or need additional information, please contact the CDC press office at media@CDC.gov or 404-639-3286.  Thank you very much for joining us today. 

OPERATOR: Thank you. That does conclude today's conference. Thank you for your participation, and you may now disconnect.  

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES