Healthier Head Start: Sodium Reduction in Early Child Education Karen Harmon, RD, CD K. Elise Lindstrom, MA, RDN Program is supported in part by the Centers for Disease Control and Prevention Cooperative Agreement #1U58DP004932.

Why should we care about sodium? 90% of Americans consume too much sodium, increasing their risk of having high blood pressure, a risk factor for heart disease and stroke. Dietary Guidelines for Americans Recommend < 2300 mg sodium/day Actual Average Daily Sodium Intake for U.S. Adults >3,300 mg/day Heart disease and stroke kill more than 800,000 Americans each year and contribute an estimated $273 billion in health care costs. 75% of the sodium is found in processed and/or restaurants food and not added at the table. Eating Habits are developed in childhood.

Learning Objectives Describe key components of a successful sodium reduction intervention. Identify successful strategies for sodium reduction which would be applied to a variety of food service settings.

Head Start SRCP Interventions Develop and Implement Food Service Guidelines/Nutrition Standards Offer Complementary Venue-Specific Consumer Information Activities Implement Menu Modifications or Meal Modifications Implement Strategies That May Enhance Acceptance of Lower Sodium Foods

Successful Strategies: Working with Distributors Convey the need for lower sodium products Increase availability of affordable lower sodium foods to Head Start and others in the region Increase Head Start purchasing of lower sodium foods

Successful Strategies: Nutrition Guidelines Shared with Food Distributors Established as FDS policy August 2015 Sustained through Personnel Changes

Outcome: Reduce Sodium Intake Baseline Year 1 Year 2 Excludes Milk Average Sodium Content (mg) Percent Change from Baseline Breakfasts: <430 mg 165 160 147 11% Lunches: <710 mg 1015 820 596 41% Snacks: <200 mg 129 153 110 15% Entrées: <480 mg 714 564 452 37% Sides: <230 mg 190 166 108 43% Four Evaluation Meals 1060 600 457 57% Average Daily Sodium Intake (Breakfast, Lunch & Snacks) 1309 1133 853 35%

Outcome: Increased Acceptance of Lower Sodium Foods Taste Testing – 75% acceptance with no significant difference in higher versus lower sodium foods Plate Waste – No increase in waste Consumer Information/Teacher Training – Changes over time assessed with NAP SACC

Successful Strategies: Consumer Information

Lessons Learned Taste Testing – great way to involve children/staff No increase in plate waste, but differences in meal component consumption Variance in food dissemination by staff Portion control/serving seconds Introduction of foods unfamiliar to children and staff Impact of food preparation changes

Successful Strategies: Menu/Meal Modifications Portion size Product substitution Dilution of sauces and gravies CONDIMENTS

Achievements Availability: Lower Sodium Foods  Accessibility: No significant cost change from BL  Y2 Acceptability: No difference in taste test between original and lower sodium foods with no increase in lunch waste. Reduce Intake: Average sodium intake by 35% Nutrition standards adopted into policy!

Thanks to Advisory Team Family Development Services, Inc. doing business as Head Start Karen Harmon, RD, Nutrition and Wellness Coordinator David Morris, Food Service Manager Toronna Chilton, Cook Marion County Public Health Department Sandra Cummings, MSW, Project Director Denise Ferguson, MS, RD, Nutrition Services Coordinator Shelley Vaughn, MS, Project Manager Elise Lindstrom, MA, RDN, Cardiovascular Nutritionist Project Evaluator Alice Lindeman, PhD, RDN, Associate Professor, Indiana University Department of Applied Health Science

Contacts Evaluator Alice Lindeman, PhD, RDN, Associate Professor in the School of Public Health, Indiana University, Bloomington, IN Telephone: (812) 855-6437 E-mail: lindema@indiana.edu Family Development Services Karen Harmon, RD, Nutrition and Wellness Coordinator Telephone: (317) 803-3823 E-mail: kharmon@fds.org Marion County Public Health Department Sandra F. Cummings, MSW, Project Director and Chronic Disease Programs Coordinator Telephone (317) 221-2096 E-mail: scumming@marionhealth.org Shelley Vaughn, MS, Project Manager, Sodium Reduction in Communities Program Telephone (317) 221-2112 E-mail: svaughn@marionhealth.org K. Elise Lindstrom, RDN, Cardiovascular Nutritionist, Sodium Reduction in Communities Program Telephone (317) 221-2112 E-mail: klindstrom@marionhealth.org