U.S. TB Infections Drop to Record Low: CDC

By  Julie Steenhuysen

United States - U.S. cases of tuberculosis fell 6.4 percent in 2011 to an all-time low, but missed a national target of eliminating the disease as cases among foreign-born individuals persisted, health officials said on Thursday.

Unless factors change significantly, the United States will not be able to eliminate TB - meaning fewer than one case per one million people - until the year 2100, according to the U.S. Centers for Disease Control and Prevention.

"Addressing the increasing difference between TB rates in foreign-born and U.S.-born persons is critical for TB elimination," the CDC said in its weekly report on death and disease, which was released ahead of World TB Day on March 24.

Overall, U.S. TB rates last year fell to 10,521 reported cases, or 3.4 cases per 100,000 people, the lowest level since national reporting began in 1953, the CDC said.

Despite these gains, the airborne infection is proving difficult to tame in some populations, especially among foreign-born individuals, blacks, Asians and people infected with HIV.

TB rates were 12 times higher among people born outside the United States. Of these infected individuals, more than half of the cases originated in just five countries: Mexico, the Philippines, Vietnam, India, and China, the CDC said.

Compared with whites, TB rates were seven times higher for Hispanics, eight times higher for blacks and 25 times higher for Asians last year.

Four states - California, Texas, New York and Florida - account for nearly half of all TB cases in the United States, according to the report.

TB is caused by the Mycobacterium tuberculosis bacteria. It can be cured with antibiotics but they must be taken daily for months to be effective. Because people do not always take the drugs as directed, multiple drug-resistant strains have emerged.

Cases of TB that are resistant to at least two common treatments, known as multidrug-resistant TB, accounted for 109 of all U.S. TB cases in 2010, the most recent year for which there are data. Foreign-born individuals accounted for 90 of these cases.

There were 4 cases of extensively drug-resistant TB - an infection that resists the most highly effective drugs - reported in the United States in 2010, all among foreign-born people.

The World Health Organization estimates that a third of the world's population is infected with the bacteria that cause TB. Last year, TB made nearly 9 million people sick and killed some 1.45 million people, according to WHO.

CDC Launching Graphic Anti-Smoking Ad Campaign

Atlanta - Tobacco taxes and smoking bans haven't budged the U.S. smoking rate in years. Now the government is trying to shock smokers into quitting with a graphic nationwide advertising campaign.

The billboards and print, radio and TV ads show people whose smoking resulted in heart surgery, a tracheotomy, lost limbs or paralysis. The $54 million campaign is the largest and starkest anti-smoking push by the Centers for Disease Control and Prevention and its first national advertising effort.

The agency is hoping the spots, which begin Monday, will persuade as many as 50,000 Americans to stop smoking.

"This is incredibly important. It's not every day we release something that will save thousands of lives," CDC Director Dr. Thomas Frieden said in a telephone interview.

That bold prediction is based on earlier research that found aggressive anti-smoking campaigns using hard-hitting images sometimes led to decreases in smoking. After decades of decline, the U.S. smoking rate has stalled at about 20 percent in recent years.

Advocates say it's important to jolt a weary public that has been listening to government warnings about the dangers of smoking for nearly 50 years.

"There is an urgent need for this media campaign," Matthew Myers, president of the Campaign for Tobacco-Free Kids, said in a statement.

The CDC was set to announce the three-month campaign on Thursday.

One of the print ads features Shawn Wright from Washington state who had a tracheotomy after being diagnosed with head and neck cancer four years ago. The ad shows the 50-year-old shaving, his razor moving down toward a red gaping hole at the base of his neck that he uses to speak and breathe.

An advertising firm, Arnold Worldwide, found Wright and about a dozen others who developed cancer or other health problems after smoking for the ads.

Federal health agencies have gradually embraced graphic anti-smoking imagery. Last year, the Food and Drug Administration approved nine images to be displayed on cigarette packages. Among them were a man exhaling cigarette smoke through a tracheotomy hole in his throat, and a diseased mouth with what appear to be cancerous lesions.

Last month, a federal judge blocked the requirement that tobacco companies put the images on their packages, saying it was unconstitutional.

Graphic ads are meant to create an image so striking that smokers and would-be smokers will think of it whenever they have an urge to buy a pack of cigarettes, said Glenn Leshner, a University of Missouri researcher who has studied the effectiveness of anti-smoking ads.

Leshner and his colleagues found that some ads are so disturbing that people reacted by turning away from the message rather than listening. So while spots can shock viewers into paying attention, they also have to encourage people that quitting is possible, he said.

The CDC campaign includes information on a national quit line and offers advice on how to kick the habit, CDC officials said.

HIV Rate Among U.S. Injection Drug Users Falls: CDC

By Julie Steenhuysen


United States - HIV infections among injection drug users in the United States have fallen by half in the past decade, but HIV testing is also down and risky behaviors such as needle-sharing persist, raising worries that progress may be short-lived, U.S. health experts said on Thursday.

A study by researchers at the U.S. Centers for Disease Control and Prevention based on a 2009 survey of 10,000 people from 20 urban areas found that 9 percent of IV drug users were infected with the human immunodeficiency virus or HIV, the virus that causes AIDS.


That compared with a rate of 18 percent in the 1990s.


"Despite the fact that we've seen declines in new HIV infections, a substantial number of IDUs (injection drug users) in major US cities are HIV-infected and their risk behavior remains fairly high," said Dr. Cyprian Wejnert, an epidemiologist at the CDC, whose study appears in the CDC's weekly report on death and disease.


"We found 9 percent of IDUs were HIV-positive and nearly half of those were unaware of their infection," Wejnert said in a telephone interview.


HIV rates have been falling in the United States, but pockets of infection continue to persist, especially in high-risk groups such as young people and men who have sex with men.

The latest survey tested individuals for HIV and asked questions about their risk behaviors and use of HIV prevention services.


It found about one third of injection drug users in the survey said they shared syringes, most said they had unprotected sex in the past year and more than half said they had more than one sexual partner.


The study also found that rates of HIV testing in this at-risk population are falling.


"While CDC recommends that individuals are tested for HIV at least annually, only 49 percent, less than half of those interviewed, reported being tested in the last 12 months," Wejnert said.

That represents a significant drop from a survey done in 2005-2006, he said.


Dr. Amy Lansky, deputy director in the Division of HIV/AIDS Prevention at CDC, said the findings will be used as CDC focuses its prevention efforts on high risk populations.


"It's a really important part of understanding the leading edge of the epidemic," she said.

"What the data from this report shows is we really do need to continue our efforts to expand HIV testing and improve testing," she said, adding that the CDC also needs to focus its prevention efforts on reaching more drug users. Such efforts include offering new sterile syringes, condoms, and substance abuse treatment.


According to the CDC, 1.2 million Americans have HIV, and 1 in 5 U.S. adults with HIV do not know they are infected.

Obama Shoots for Science Increase

By Ivan Semeniuk, Meredith Wadman, Susan Young, Eric Hand, Eugenie Samuel Reich, and Richard Monastersky

From Nature Magazine

“It’s not every day you have robots running through your house,” Barack Obama quipped last week at the White House science fair, a showcase for student exhibitors that also gave the US president a chance to reiterate a favourite theme. Science and technology, he said, “is what’s going to make a difference in this country, over the long haul”.

Obama would clearly like to see many more robots, as well as researchers and engineers, running around in the future, a wish reflected in his budget request for fiscal year 2013, released on 13 February. The document’s message is one of big ambitions with fewer resources.

A year ago, Obama proposed bold increases for science agencies, but a Congress intent on curbing government spending refused to back many of them. This time, the White House has scaled back in several areas but boosted overall funding for non-defence research and development by 5%, pushing it up to US$64.9 billion.


“Overall, the budget sustains an upward trend,” says John Holdren, director of the White House Office of Science and Technology Policy in Washington DC. “Because of fiscal restraints, it’s not at the rate we preferred.”

With an election coming this November, House Republicans are unlikely to be generous with the president’s request. As in previous years, Congress could delay action on the budget, especially if it decides to wait for voters to weigh in on Obama’s presidency before making its decision. And the spectre of a severe across-the-board cut dangles over the government because of an act introduced last year that aims to chop $1.2 trillion from spending, starting in January 2013.

Here is an overview of what the president’s request would mean in key science domains (see ‘Tough decisions’).

Biomedicine and public health

The National Institutes of Health (NIH) in Bethesda, Maryland, by far the largest US research agency, sees its budget held level at $30.7 billion — a far cry from the $1-billion increase Obama proposed a year ago. Despite the ceiling, Lawrence Tabak, the NIH’s principal deputy director, sees the budget as “continuing our priorities in basic science”, and it allows the agency to boost the number of new and competing grants it funds by 8%.

The newly launched National Center for Advancing Translational Sciences (NCATS) in Bethesda will grow by 11%, to $639 million. Much of the rise goes to the Cures Acceleration Network, an effort to spur development of badly needed medicines through bold, multimillion-dollar grants. The programme’s allocation grows fivefold next year, to $50 million.

Accomplishing all this within a flat budget requires cuts. Losers include the National Children’s Study, a long-term study of early influences on the health of more than a hundred thousand children, which received $194 million in 2012, but has been cut by $29 million; and the Institutional Development Award programme, aimed at developing research infrastructure in rural and undeserved states, which loses nearly $48 million.
To pinch the pennies that will make new grants possible, the NIH plans to eliminate inflationary increases for some existing grants, cut others by 1% and keep grants seeking renewal at current levels. The agency predicts that these measures would boost the success rate for grant applications, currently at a historic low of 18%, but only to 19%.

The flat-lined budget has drawn bleak appraisals from NIH advocates. “We are talking about a budget that is probably close to 20% smaller than it was a decade ago, adjusted for inflation,” says David Moore, senior director for government relations at the Association of American Medical Colleges in Washington DC.
Jennifer Zeitzer, director of legislative relations at the Federation of American Societies for Experimental Biology in Bethesda, says that her organization will work with research champions to persuade Congress to boost the allocation for the NIH. The president’s request, she says, “is not what we need to take advantage of the scientific opportunities that are before us”.

The outlook is even less favorable for the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, which has had its budget cut by 12%, to make a total of 22% in cuts since 2010. Those cuts are, in part, counterbalanced by bringing in funds from a long-standing health-services evaluation fund and from the Prevention and Public Health Fund, which is part of the health reform law that Obama introduced in 2010.
The dependence on the Prevention and Public Health Fund worries public-health advocates. Using the fund to patch holes in the CDC’s budget is “troubling”, says Emily Holubowich, executive director of the Coalition for Health Funding, based in Washington DC. “The future of the fund is tenuous at best.”

Obama has also kept the budget mostly flat for the Food and Drug Administration (FDA) in Silver Spring, Maryland. However, the agency will receive a $583-million bolus from new industries, mainly from food-registration and inspection fees and from makers of generic drugs and biosimilars.

The FDA has already been criticized for becoming too reliant on industry funding, but Margaret Hamburg, the FDA’s commissioner, says that the fees are needed to ensure effective and timely drug and device review. “There is a common good here,” she says.

Physical sciences

The White House continues to support a long-term doubling of budgets for physical-science agencies, including the National Science Foundation (NSF) in Arlington, Virginia; the Department of Energy’s Office of Science in Washington DC; and the National Institute of Standards and Technology (NIST) in Gaithersburg, Maryland. The doubling, relative to 2006, is a goal of the America COMPETES Act, introduced under former President George W. Bush that year, and signed into law in 2007. Congressional appropriators have, however, slowed the pace of these agencies’ growth considerably since then (see ‘A long way to go’).
The budget also shifts funding towards the applied end of the research spectrum, where advances should translate into economic gains more quickly. It continues to fund I-Corps, a programme launched last year that partners entrepreneurs with scientists seeking to test the marketability of their research. And advanced manufacturing, which supports industry by developing measurement capabilities and standards to guide new product development, gets $149 million — money that NSF director Subra Suresh says will help to stem a decline in US manufacturing. “In times of constrained budgets, we need to be crystal clear about why NSF matters,” Suresh says.

The NSF emerges as a clear winner in Obama’s request, with a 5% boost to its bottom line. And one thing is very clear at the agency: researchers pursuing interdisciplinary research will be rewarded, with $63 million allocated to a programme that supports such work.

The NIST also gets a large increase, much of which is aimed at advanced manufacturing, including both a robotics programme and a ‘materials genome’ initiative that aims to speed up the development of new materials.

The Department of Energy’s Office of Science receives a more modest rise, much of which goes to its national laboratories and Energy Innovation Hubs. Several basic-research programmes are trimmed, including nuclear physics and high-energy physics, a shift that is consistent with the administration’s emphasis on applied research that is most relevant to energy technology.

“Basic research is systematically down,” says Milind Diwan, a physicist at Brookhaven National Laboratory in Upton, New York, and co-spokesman for a planned particle physics experiment that received a drop in funding. “Those of us in fundamental-research have to live within those priorities.”

At NASA, the talk is of “tough but sustainable choices” for an agency that would receive $17.7 billion in 2013, $59 million less than in 2012. Its science budget drops by 3.2%, but planetary science bears the brunt of that, with a cut of 21%. For years, NASA has been pursuing plans with the European Space Agency for joint missions to Mars in 2016 and 2018. But on Monday, NASA administrator Charles Bolden pulled the plug. “We just cannot do another flagship right now,” he said. Officials fear that the costs for these missions would spiral out of control, as they have for the $8.8-billion James Webb Space Telescope, a follow-on to the Hubble telescope that is slated for a 2018 launch.

The pinch will perhaps be felt most keenly at the Jet Propulsion Laboratory (JPL) in Pasadena, California, the traditional home of the Mars Exploration Program. Last year, the laboratory had to lay off the equivalent of 246 full-time employees, reducing its staff to 5,047. When the $2.5-billion Mars Science Laboratory lands in August, the JPL will have to quickly find new work for a few hundred employees so the latest Mars cancellations make more lay-offs likely. “Our expectation was that we’d have another mission to move these people on to,” says Richard O’Toole, the JPL’s manager of legislative affairs. “We definitely feel the pressure.”

Energy, Earth and environment

In Obama’s plan, spending on energy efficiency and renewable energy rises by $457 million, to $2.3 billion, with the largest increases targeting advanced manufacturing, and vehicle and building technologies. These programmes, run by the Department of Energy, are aimed at bolstering the competitiveness of industry. “Our motto is ‘Invented in America, made in America, sold worldwide’,” says energy secretary Steven Chu.
Included in the package are increases for research in solar energy, bioenergy and fossil fuels, including $155 million for carbon capture and storage systems. But there are reductions and shifts as well: the budget for wind power remains unchanged but is allocated mainly to offshore technologies. Spending on nuclear energy continues an ongoing move toward small, modular reactors.

The National Oceanic and Atmospheric Administration (NOAA) in Washington DC receives a boost of 3%. That isn’t enough to offset both inflation and rising salaries, but nonetheless protects a core agency priority: a programme of polar-orbiting weather and environment satellites that has been troubled by delays and cost overruns. Last year, NOAA requested a hefty increase of $688 million to get the programme back on track, but received just under two-thirds of that. This year, the satellite programme is boosted by $169 million.

NOAA watchers looking for signs of the president’s proposed reorganization of the Department of Commerce, which would move NOAA from there to the Department of the Interior, found no trace of the plan in the 2013 budget. The budget is also silent on another big initiative, the creation of a climate service within NOAA.

In what could be a third straight year of declining budgets for the US Environmental Protection Agency (EPA) in Washington DC, the agency’s funding has been slashed by 1%, to $8.3 billion, almost $2 billion less than in 2010. Nonetheless, funding for initiatives that target climate change and the environment rises slightly, to $807 million, protecting core science and regulatory efforts. To compensate, the White House has cut $359 million from a pair of clean-water grant programmes. These programmes are popular in Congress, and law-makers have reversed similar cuts in the past.

“They did a pretty good job in making sure we are not hurting our environment and conservation programmes,” says Scott Slesinger, legislative director at the Natural Resources Defense Council in Washington DC. But Slesinger expects Congress to inflict further cuts.

With a 3% rise for its overall budget, the US Geological Survey (USGS) in Reston, Virginia, fares better than most mission-oriented science agencies. The agency’s research and development portfolio expands from $675.5 million to $726.5 million. Part of the increase includes an extra $13 million for research on the effects of hydraulic fracturing, the process used by the oil and gas industry to squeeze hydrocarbons out of non-porous rock. The president has also pumped an extra $10.3 million into natural-hazards work, including $2.4 million for research on quick responses to earthquakes, volcanic eruptions and landslides, and $1.6 million to study the risk of earthquakes in the eastern United States, which was shaken by a magnitude-5.8 tremor last August.

Daniel Sarewitz, a geoscientist and co-director of the Consortium for Science, Policy and Outcomes at Arizona State University in Tempe, supports the increase for the USGS. “The survey doesn’t get a lot of attention, but it does things that are important for the nation and it’s structured in ways that make its science very useful.”

Education

The administration has taken pains to advertise a $3-billion effort to increase and strengthen the future US science and technology workforce. For example, a combined expenditure of $135 million by the Department of Education and the NSF aims to boost the number of science and mathematics teachers by 100,000 over the coming decade. An even more ambitious effort allocates an additional $81 million to increasing the number of science graduates by one million — roughly 30% more than there are today — over the same period. According to Carl Wieman, associate director for science at the Office of Science and Technology Policy, simply reducing the attrition of science majors, which currently runs as high as 60%, could drive much of that increase.

Obama made a point of previewing both initiatives during the White House science fair, telling students there, “You give me confidence that America’s best days are still to come.” Now, as the budget goes to Congress, the battle to support lofty goals with real dollars begins a new round.

Salt Intake From Bread Higher Than You Think: Study

Atlanta - It seems high amounts of salt are in many places, and almost a certain thing in processed and canned foods. Now a study reveals bread is the main source of salt in the American diet.


The Centers for Disease Control (CDC) released a study that names the top ten sources for salt. Surprisingly junk food such as potato chips, pretzels, and popcorn were at the bottom of the list.

While not the saltiest foods, breads and rolls tend to be consumed by more people than other foods. This means breads and rolls, while they make up just seven percent of an average American's salt intake, can add salt intake at an alarming rate. What complicates matters is different types of the same food, in this example bread, can vary greatly. White bread can have anywhere between 80 and 230 milligrams of sodium per slice and a small bag of potato chips can hold 450 to more than 1,000 milligrams.


The finding that ten simple foods are responsible for slightly more than 40 percent of overall salt intake surprised even CDC officials.

According to the study Americans consume more than 3,300 milligrams of sodium a day, while the recommended amount is 2,300 and even less for some people with health issues.

Rank†	Food category§	Age group (yrs)
		≥2	2–19	2–5	6–11	12–19	≥20	20–50	51–70	≥71
		% (SE)	% (SE)	% (SE)	% (SE)	% (SE)	% (SE)	% (SE)	% (SE)	% (SE)
1	Breads and rolls	7.4 (0.2)	6.9 (0.4)	6.5 (0.5)	7.8 (0.6)	6.5 (0.4)	7.5 (0.2)	7.2 (0.3)	7.8 (0.4)	9.6 (0.3)
2	Cold cuts/cured meats	5.1 (0.3)	4.4 (0.4)	3.4 (0.5)	4.3 (0.4)	4.9 (0.7)	5.3 (0.3)	5.5 (0.5)	4.6 (0.2)	6.0 (0.5)
3	Pizza	4.9 (0.2)	7.3 (0.4)	4.8 (0.7)	7.2 (0.6)	8.2 (0.7)	4.1 (0.2)	5.0 (0.4)	3.0 (0.4)	1.7 (0.2)
4	Poultry	4.5 (0.2)	5.5 (0.4)	5.5 (0.4)	4.7 (0.4)	6.0 (0.6)	4.2 (0.3)	4.5 (0.3)	3.9 (0.3)	2.7 (0.3)
5	Soups	4.3 (0.3)	4.0 (0.2)	5.3 (0.9)	3.6 (0.4)	3.9 (0.4)	4.4 (0.4)	4.2 (0.4)	4.6 (0.7)	5.7 (0.7)
6	Sandwiches¶	4.0 (0.3)	4.4 (0.3)	3.5 (0.3)	3.9 (0.3)	5.0 (0.5)	3.9 (0.3)	4.5 (0.3)	3.2 (0.6)	3.7 (0.5)
7	Cheese**	3.8 (0.2)	3.8 (0.3)	4.2 (0.4)	3.7 (0.3)	3.9 (0.4)	3.8 (0.2)	3.9 (0.2)	3.5 (0.2)	1.8 (0.3)
8	Pasta mixed dishes††	3.3 (0.2)	3.8 (0.4)	4.0 (0.6)	4.0 (0.5)	3.7 (0.4)	3.1 (0.2)	3.4 (0.4)	2.4 (0.5)	2.9 (0.3)
9	Meat mixed dishes	3.2 (0.3)	2.1 (0.4)	—§§	2.2 (0.5)	1.9 (0.4)	3.6 (0.3)	3.5 (0.3)	3.6 (0.7)	4.2 (0.7)
10	Savory snacks¶¶	3.1 (0.2)	4.4 (0.3)	3.4 (0.2)	4.6 (0.4)	4.6 (0.6)	2.8 (0.2)	2.8 (0.2)	3.0 (0.4)	1.6 (0.2)
Mean daily sodium consumption (mg) (SE)		3,266(40)	2,957 (53)	2,245 (54)	2,944 (72)	3,310 (70)	3,372 (48)	3,568 (58)	3,239 (73)	2,658 (77)
Unweighted no. of participants in sample		7,227	2,544	662	901	981	4,683	2,280	1,549	854
Abbreviation: SE = standard error. * The population proportion (%) of sodium consumed is defined as the sum of the amount of sodium consumed from each specific food category for all participants divided by the sum of sodium consumed from all food categories for all participants multiplied by 100. All estimates use two observations per person, take into account the complex sampling design, and use 2-day diet sample weights to account for nonresponse and weekend/weekday recalls. Standard errors of the estimates are in parentheses. † Rank based on population proportions of sodium consumed for overall U.S. population aged ≥ 2 years. Columns for other age groups are ordered by this ranking. Additional information regarding food categorization is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6105-table.htm. § Food categories contributing ≥ 3% to overall sodium consumption within specific age groups but not listed among the top 10 contributors were as follows: persons aged 2–19 years, frankfurters and sausages (3.7%) and ready-to-eat cereal (3.2%); 2–5 years, frankfurters and sausages (5.4%), whole and reduced fat milk (4.7%), and ready-to-eat cereal (3.7%); 6–11 years, frankfurters and sausages (4.1%), and ready-to-eat cereals (3.4%); 12–19 years, burritos, tacos, and tamales (4.0%); 20–50 years, burritos, tacos, tamales (3.4%); 51–70 years, salad dressings and vegetable oils (3.5%); ≥71 years, biscuits, muffins, quick breads (3.2%). ¶ Sandwiches as identified by a single WWEIA code. ** Natural and processed cheese. †† Pasta mixed dishes category does not include macaroni and cheese, which is its own category. §§ Data are statistically unreliable; relative standard error ≥ 30%. ¶¶ Includes snacks such as chips, puffs, popcorn, and pretzels.

TABLE 2. Ranked population proportions of sodium consumed* by persons aged ≥2 years, by selected food categories, sex, and selected race/ethnicities — What We Eat in America (WWEIA), National Health and Nutrition Examination Survey, United States, 2007–2008
Rank†	Food category§	Sex		Race/Ethnicity
		Male	Female	non-Hispanic white	non-Hispanic black	Mexican-American
		% (SE)	% (SE)	% (SE)	% (SE)	% (SE)
1	Breads and rolls	7.4 (0.3)	7.4 (0.2)	7.9 (0.3)	6.7 (0.3)	5.2 (0.2)
2	Cold cuts/cured meats	5.8 (0.5)	4.3 (0.2)	5.5 (0.4)	4.6 (0.4)	4.1 (0.3)
3	Pizza	5.7 (0.3)	4.0 (0.3)	4.9 (0.2)	5.6 (0.6)	5.2 (0.2)
4	Poultry	4.5 (0.3)	4.5 (0.2)	4.1 (0.3)	7.2 (0.5)	4.5 (0.3)
5	Soups	4.3 (0.4)	4.4 (0.3)	3.6 (0.3)	3.2 (0.5)	6.2 (0.8)
6	Sandwiches¶	4.3 (0.4)	3.7 (0.3)	3.7 (0.4)	6.0 (0.7)	4.1 (0.4)
7	Cheese**	3.7 (0.1)	3.9 (0.3)	4.1 (0.2)	3.0 (0.2)	3.2 (0.2)
8	Pasta mixed dishes††	3.2 (0.2)	3.4 (0.3)	3.5 (0.2)	3.1 (0.2)	1.8 (0.2)
9	Meat mixed dishes	3.1 (0.2)	3.4 (0.5)	3.6 (0.3)	2.3 (0.2)	2.0 (0.2)
10	Savory snacks§§	2.9 (0.2)	3.4 (0.2)	3.3 (0.2)	3.2 (0.2)	2.8 (0.2)
Mean daily sodium consumption (mg) (SE)		3,760 (57)	2,828 (36)	3,324 (49)	3,116 (51)	3,037 (49)
Unweighted no. of participants in sample		3,557	3,670	3,115	1,600	1,407
Abbreviation: SE = standard error. * The population proportion (%) of sodium consumed is defined as the sum of the amount of sodium consumed from each specific food category for all participants divided by the sum of sodium consumed from all food categories for all participants multiplied by 100. All estimates use two observations per person, take into account the complex sampling design, and use 2-day diet sample weights to account for nonresponse and weekend/weekday recalls. Standard errors of the estimates are in parentheses. † Rank based on population proportions of sodium consumed for overall U.S. population aged ≥ 2 years. Columns for other age groups are ordered by this ranking. Additional information regarding food categorization is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6105-table.htm. § Food categories contributing ≥ 3% to overall sodium consumption within specific age groups but not listed among the top 10 contributors were as follows: males, frankfurters and sausages (3.3%), and burritos, tacos, and tamales (3.2%); females, frankfurters and sausages (3.3%), burritos, tacos, and tamales (3.2%); non-Hispanic blacks, frankfurters and sausages (5.0%), salad dressings and vegetable oils (2.4%); Mexican-Americans, burritos, tacos, and tamales (6.8%), tortillas (4.7%), and eggs and eggs mixed dishes (3.8%). ¶ Sandwiches as identified by a single WWEIA code. ** Natural and processed cheese. †† Pasta mixed dishes category does not include macaroni and cheese, which is its own category. §§ Includes snacks such as chips, puffs, popcorn, and pretzels.

TABLE 3. Population proportions of sodium consumed* and mean sodium density,† by food source category and age group — What We Eat in America, National Health and Nutrition Examination Survey, United States, 2007–2008
Age group (yrs)	Food source category§
	Store	Restaurant with fast food/pizza	Restaurant with waiter/waitress	Cafeteria at school/child care center	Other
≥2
Population proportion, % (SE)	65.2 (1.0)	13.6 (0.7)	11.2 (0.7)	—	10.0 (0.5)
Sodium density, mg/1,000 kcal	1,519 (10)	1,848 (16)	2,090 (32)	—	1,676 (21)
2–19
Population proportion, % (SE)	65.5 (1.1)	13.7 (0.6)	6.3 (0.7)	8.1 (1.2)	6.3 (0.5)
Sodium density, mg/1,000 kcal	1,509 (14)	1,745 (20)	1,970 (63)	1,701 (22)	1,501 (58)
≥20
Population proportion, % (SE)	65.1 (1.3)	13.6 (0.8)	12.7 (0.8)	—	8.6 (0.4)
Sodium density, mg/1,000 kcal	1,522 (12)	1,882 (23)	2,110 (29)	—	1,712 (24)
Abbreviation: SE = standard error. * The populat2on proportion (%) of sodium consumed is defined as the sum of the amount of sodium consumed from each specific food source category for all participants divided by the sum of sodium consumed from all food source categories for all participants multiplied by 100. All estimates use two obs2rvations per person, take into account the complex sampling design, and use 2-day diet sample weights to account for nonresponse and weekend/weekday recalls. Standard errors of the estimates are in parentheses. The unweighted number of participants in each sample was 7,227 (2,554 children and 4,683 adults). † A measure that accounts for differences in the amount of calories consumed from foods obtained from each source, defined as mg of sodium per 1,000 kcal. § Food source categories were analyzed from responses to the question, "Where did you get this (most of the ingredients for this) [food name]?" "Cafeteria at school" and "child care center" were combined in one category. Sources other than those shown were combined under "other" and included "from someone else/gift" (3.9% population proportion among those aged ≥2 years), cafeteria at school/child care center (2.1%), and 19 other sources (e.g., vending machine), including "missing," "do not know," and "other/specify" (<1%). For persons not aged 2–19 years, "cafeteria at school" and "child care center" were grouped in the "other" category because <1% reported consumption of sodium from foods obtained at these locations.

TABLE 4. Percent of persons aged > 2 years who consumed the food from the specified food category* and among those persons, the proportion who obtained the food from stores, restaurants, or other sources — What We Eat in America (WWEIA), National Health and Nutrition Examination Survey, United States, 2007–2008
Rank	Food category	No. of consumers§	% (SE)¶	Food source category†
				Store % (SE)	Restaurant with fast food/pizza % (SE)	Restaurant with waiter/waitress % (SE)	Other % (SE)
1	Breads and rolls	5,672	79.9 (0.9)	76.4 (1.3)	6.7 (0.8)	8.7 (0.6)	8.2 (0.7)
2	Cold cuts/cured meats	2,469	33.9 (1.2)	78.8 (1.1)	6.5 (1.0)	5.4 (0.9)	9.3 (1.2)
3	Pizza	1,569	21.9 (0.7)	27.2 (3.1)	51.2 (3.5)	13.2 (2.1)	8.4 (1.1)
4	Poultry	3,659	48.3 (1.3)	46.0 (2.4)	26.6 (1.9)	16.7 (1.2)	10.7 (1.3)
5	Soups	1,670	22.0 (1.3)	77.4 (4.3)	—**	12.5 (3.6)	7.5 (1.1)
6	Sandwiches††	1,480	20.6 (1.1)	11.9 (1.2)	84.5 (1.4)	—	3.0 (0.8)
7	Cheese§§	3,833	56.2 (1.9)	72.4 (1.2)	10.5 (1.0)	8.2 (0.6)	8.9 (0.9)
8	Pasta mixed dishes¶¶	1,183	17.6 (0.9)	82.2 (3.2)	—	7.4 (1.6)	8.8 (1.5)
9	Meat mixed dishes	1,417	21.8 (1.4)	76.7 (3.5)	5.4 (1.2)	9.2 (2.3)	8.7 (2.0)
10	Savory snacks***	3,599	50.7 (1.5)	81.7 (1.5)	3.6 (1.0)	2.5 (0.4)	12.2 (1.2)
* Ranked by population proportions (%) of sodium consumed by persons aged ≥2 years. The population proportion (%) of sodium consumed is defined as the sum of the amount of sodium consumed from each specific food source category for all participants who consumed foods within the specified food category divided by the sum of sodium consumed from all food source categories for all participants who consumed foods within the specified food category multiplied by 100. All estimates use two observations per person, take into account the complex sampling design, and use 2-day diet sample weights to account for nonresponse and weekend/weekday recalls. Standard errors of the estimates are in parentheses. Data were limited to the food categories ranked in the top 10 in population proportion of sodium consumed by persons aged ≥2 years. † Food source categories were analyzed from responses to the question, "Where did you get this (most of the ingredients for this) [food name]?" Sources other than those shown were combined under "other" and included "from someone else/gift" (3.9% population proportion among those aged ≥2 years), cafeteria at school/child care center (2.1%), and 19 other sources (e.g., vending machine), including "missing," "do not know," and "other/specify" (<1%). § No. of participants aged ≥2 who reported consumption of at least one food within the selected food category on either day of the two 24-hour dietary recall. ¶ Percentage of participants aged ≥2 years who reported consumption of at least one food within the selected food category on either day of the two 24-hour dietary recalls. ** Data are statistically unreliable, relative standard error ≥30%. †† Sandwiches as identified by a single WWEIA code. §§ Natural and processed cheese. ¶¶ Pasta mixed dishes category does not include macaroni and cheese, which is its own category. *** Includes snacks such as chips, puffs, popcorn, and pretzels.

FDA Urged to Require Sodium Reduction in Food Supply

71 Percent of Americans Believe Industry Should Lower Salt

Washington D.C. - January 30 - Voluntary efforts by industry to reduce sodium levels in the food supply have failed, according to comments filed with the Food and Drug Administration last week by the nonprofit Center for Science in the Public Interest. On Friday CSPI urged the agency to create strong, but realistic, mandatory regulations to reduce sodium levels in restaurant and packaged foods. According to a recent survey commissioned by CSPI, the public sees the need to lower sodium. 71 percent of Americans indicated that the food industry had a responsibility to reduce the sodium content of their foods, and 58 percent support a government requirement to reduce the sodium in processed and restaurant foods.

“Overconsumption of sodium is one of the single greatest causes of hypertension and cardiovascular disease, and restaurant and packaged foods—not salt shakers—are far and away the largest contributors of sodium in the American diet,” said CSPI deputy director of health promotion policy Julie Greenstein. “Unfortunately, the food industry has failed to significantly bring down sodium levels despite 40 years of governmental admonitions. It’s time for the FDA to step in and require reasonable reductions.”

The U.S. government’s 2010 Dietary Guidelines for Americans recommends that people with hypertension, those who are middle-aged or older, and African Americans should consume no more than 1,500 milligrams of sodium per day. According to the Center for Disease Control, about 70 percent of adults fall into those categories, yet current average daily consumption is actually closer to 4,000 mg. Recently, the American Public Health Association passed a resolution that calls on FDA to begin regulating sodium in the food supply within one year and to establish a timetable for gradually reducing sodium in the food supply by 75 percent over 10 years. CSPI’s filing notes that reducing sodium consumption would save billions of dollars in medical costs, and upwards of 150,000 lives annually.

Overwhelming evidence indicates that excess sodium levels pose significant health risks, but consumer education efforts are poorly funded and ineffective, according to CSPI, making efforts to reform dietary habits of Americans difficult. A recent survey indicates that 59 percent of Americans are “not concerned” about their sodium intake. As a result, an Institute of Medicine committee recommended mandatory regulations limiting sodium levels to improve public health and decrease healthcare costs.

Many frozen dinners and canned foods contain high amounts of sodium. Boston Market frozen Meatloaf with Mashed Potatoes and Gravy has 1,460 mg of sodium per serving (about one day’s worth). Marie Callender’s frozen Creamy Chicken and Shrimp Parmesan has 1,200 mg of sodium (almost a day’s worth). One of the worst restaurant offenders is Applebee’s Provolone-Stuffed Meatballs with Fettuccine, which has 3,700 mg of sodium (more than two days’ worth). Denny’s Spicy Buffalo Chicken Melt has 3,760 mg of sodium (two and a half days’ worth).