1. 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 #1U58DP

2. 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.

3. 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.

4. 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

5. 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

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

7. 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%

8. 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

9. Successful Strategies: Consumer Information

10. 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

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

12. 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!

13. 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

14. Contacts
Evaluator
Alice Lindeman, PhD, RDN, Associate Professor in the School of Public Health, Indiana University, Bloomington, IN
Telephone: (812)
Family Development Services
Karen Harmon, RD, Nutrition and Wellness Coordinator Telephone: (317)
Marion County Public Health Department
Sandra F. Cummings, MSW, Project Director and Chronic Disease Programs Coordinator Telephone (317)
Shelley Vaughn, MS, Project Manager, Sodium Reduction in Communities Program Telephone (317)
K. Elise Lindstrom, RDN, Cardiovascular Nutritionist, Sodium Reduction in Communities Program
Telephone (317)