In the most recent report from the World Health Organization on mortality and burden of disease attributable to major risks (Global Health Risks), nearly 1.7 million deaths were attributed to low intake of fruits and vegetables globally in 2004 (Table A3 WHO report 2009). In that report, insufficient intake of fruits and vegetables was estimated to have caused 14% of stomach cancer deaths, 11% of ischemic heart disease deaths and about 9% of stroke deaths world wide. The primary health benefit identified as relating to fruit and vegetables intake is its impact on reducing cardiovascular disease but also on the reduction of risk of specific cancers.

Despite the well-known understanding that fruits and vegetables should be included in a healthy diet, Americans are still falling far short of the recommended intake.  A recent report in the CDC Morbidity and Mortality Weekly Report (MMWR) released Sept 10, 2010 shows that not a single state in the U.S. met the national Healthy People 2010 targets for fruit & vegetable consumption. The CDC report estimates that in 2009, about a third (32.5%) of adults in the U.S. consumed fruit two or more times a day, and just over a quarter (26.3%) consumed vegetables three or more times a day – both far less than national targets. These data were developed from the analysis of the CDC Behavioral Risk Factor Surveillance System and underscore the need for more drastic national, state, and community action to increase fruit and vegetable intake.

It is clear that more needs to be done to improve access, availability and affordability of fruits and vegetables. Some of the challenges the public health community faces are:

• How do we increase the fruit and vegetable food supply (our supply chain) with the limited and shrinking availability of agricultural land?
• How do we overcome the barriers such as accessibility, affordability, taste and convenience to consuming fruit and vegetables?
• How can we deliver the goodness of fruit and vegetables in minimally processed forms that deliver the positive health impact of whole fruits and vegetables?
• How can we educate people, starting at a young age about the benefits of fruits and vegetables and encourage children to make eating fruits and vegetables a lifetime habit?

At PepsiCo we are taking a new look at these complicated issues and subsequent blogs will address the challenges listed above. Are there any other issues that you, our readers, would like us to consider?

A recent report from the U.S. Centers for Disease Control and Prevention (CDC) shows that 9 out of 10 Americans exceed the limit recommended for daily sodium intake. In fact, for the group of Americans whom a lower dietary intake of sodium is important, the amount of sodium consumed was more than double the recommended limit.

The CDC report also showed that only 9.6% of U.S. adults were below the recommended dietary limit of 2,300 mg per day for sodium; and only 5.5% among the group recommended to limit sodium intake to less than 1,500 mg per day achieved that target.  Overall, the average sodium consumption for U.S. adults was 3,466 mg per day, far in excess of the 2,300 mg per day recommended.  In the group of adults recommended to limit sodium intake to less than 1,500 mg per day, the actual intake averaged 3,366 mg per day. Excess dietary intake of sodium is not just an American issue but a genuine global health concern as emphasized by the World Action on Salt and Health and the World Health Organization.

Why is an excess intake of sodium a concern?  The scientific evidence is compelling that excess dietary sodium is associated with major adverse health outcomes, and that reducing this excess can be a cost-effective action that leads to a lower rate of new heart attack and stroke, as well as a lower death rate in all Americans, especially black men and women.

It has been estimated that 77% of dietary sodium intake in the U.S. comes from processed foods while another 11 percent comes from salt added at the table or during cooking. In the CDC report, most of the daily sodium consumed came from grain products such as yeast breads (36.9%) and meats, poultry, fish, and mixtures (27.9%), followed by vegetable products (12.4%).  The USDA has produced a list of the top products that contribute the most to daily sodium intake.

For any large scale sodium reduction strategy to be effective, it must engage all members of the entire food system including ingredient manufacturers, retailers, restaurants and especially the food industry.  PepsiCo has set a global goal and has made a commitment to reduce the average amount of sodium per serving in key global food brands, in key countries, by 25 percent by 2015, with a 2006 baseline. Given the capability we have today and substantial investments planned over the next 5 years, we believe we can achieve this goal.

For PepsiCo to achieve sodium reductions of 50% and greater, significant scientific and technological breakthroughs will be required and engagement of the broader scientific community is crucially needed. However, discussions of dietary sodium reductions today have typically been limited to public health officials, policy makers, health care providers and food industry scientists.  Conversations need to be broadened to include more than just these professionals. ‪

Input of scientists with expertise in taste perception; neurosensory receptor activation and signal transduction mechanisms; molecular and biophysical structure; and physiological properties of sodium salts is required to drive innovation.  We also need to engage scientists with expertise in socio-ecological determinants of lifestyle choices, behavioral economics, and choice architecture who can help nudge the public towards requesting and choosing foods and snacks with a reduced sodium content.‪

In the interim, we at PepsiCo are taking action today to increase the use of fruits, vegetables, whole grains, seeds, legumes, and nuts for which scientific evidence of health benefits exist.  In addition to our attention to sodium, we continue to invest in research and development and explore other opportunities (such as reducing added sugars, the saturated fat content, and calorie-density) to expand our product offerings.  We look forward to continuing the conversation on sodium and receiving input that may lead to even greater sodium reduction in foods without compromising taste, quality, and food safety.

References

1. CDC. Sodium Intake Among Adults — United States, 2005−2006. Morbidity and Mortality Weekly Report; June 25, 2010; 59(24);746-749. URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5924a4.htm.
2. World Action on Salt and Health (WASH). Salt & Health. URL: http://www.worldactiononsalt.com/health/salt_health.htm.
3. World Health Organization. Sodium intakes around the world. Background document prepared for the Forum and Technical meeting on Reducing Salt Intake in Populations (Paris 5-7th October 2006). URL: http://www.who.int/dietphysicalactivity/Elliot-brown-2007.pdf.
4. Bibbins-Domingo K, et al. Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease. The New England Journal of Medicine February 18, 2010; 362(7):590-599. URL: http://content.nejm.org/cgi/content/abstract/362/7/590
5. PepsiCo. 2009 Annual Report. Performance with Purpose – The Promise of PepsiCo. URL: http://www.pepsico.com/annual09/human_sustainability.html.
6. USDA.  National Nutrient Database for Standard Reference, Release 18; URL: http://www.nal.usda.gov/fnic/foodcomp/Data/SR18/nutrlist/sr18w307.pdf.
7. Mattes RD, Donnelly D.  Relative contributions of dietary sodium sources. Journal of the American College of Nutrition 1991;10(4):383-393.  URL: http://www.jacn.org/cgi/content/abstract/10/4/383?ijkey=7496e0ca4e5e9caa2531f3ceebdcad5cb082678c&keytype2=tf_ipsecsha
8. USDA. Could Behavioral Economics Help Improve Diet Quality for Nutrition Assistance Program Participants? DR Just, L Mancino, B Wansink (eds); Economic Research Report no. 43, June 2007. URL: http://www.ers.usda.gov/publications/err43/err43.pdf.

Note: The views expressed here represent the personal views of the authors and not necessarily the views of PepsiCo, Inc.

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