Illustration of salt on a spoonWhile the Food and Drug Administration has been mulling over voluntary guidelines for manufacturers to reduce sodium in packaged food, companies and at least one city, New York, have taken actions to reduce sodium intake.

Beginning in December, New York will require chain restaurants to put salt-shaker symbols on menus to show when meals have more than the 2,300 mg of sodium. The city’s Board of Health voted unanimously last month on the requirement.

High levels of sodium have been attributed to high blood pressure, which can lead to heart disease and stroke. The American Heart Association recommends that most adults consume no more than 1,500 milligrams of sodium a day, but the average American consumes roughly 3,400 milligrams daily — about 1½ teaspoons.

“In order to meet our goal to improve cardiovascular health and reduce death by cardiovascular disease and stroke by 20 percent by the year 2020, we must tackle high blood pressure. One fundamental way to do that is by reducing sodium intake. It will save lives,” said AHA President Mark Creager, M.D., a cardiovascular disease specialist.

The family salt shaker isn’t the main culprit for high sodium diets. Nearly 80 percent of the salt in the typical American diet comes from food prepared with packaged goods and in restaurant meals.

Top sources in the American diet include the “salty six”: bread, cold cuts/cured meats, pizza, poultry, soup, and sandwiches. Salt can be added to foods to preserve the food or to maintain texture, appearance and taste. It can also be used to increase shelf-life and to sustain quality when packaged food is reheated.

In the summer of 2014, the FDA said it would issue voluntary guidelines for food producers to reduce sodium levels based on data from a 2010 Institute of Medicine report. It didn’t give a time frame for its release.

Still, many companies already have made moves to cut salt and advocates say an additional FDA nudge could make inroads in the country’s cardiovascular health.

Walmart is working through 2015 with suppliers to reformulate thousands of packaged food items to reduce sodium by 25 percent, while food giant ConAgra Foods said it cut sodium by 20 percent. Subway restaurants announced in 2011 it would make a 28 percent reduction in its Fresh Fit sandwich menu.

In New York, officials are working with The National Salt Reduction Initiative to set voluntary targets for salt levels in 62 categories of packaged food and 25 categories of restaurant food. The NRSI is a partnership of more than 90 state and local health authorities and national health organizations, including the AHA.

The Salt Institute, a sodium industry trade group, opposes such moves. The group has questioned the effectiveness of sodium warnings, said Americans don’t want such guidelines and claimed that people are eating safe amounts of sodium.

But a study published last year in the New England Journal of Medicine concluded that 1.65 million deaths from cardiovascular disease each year around the world can be attributed to high sodium consumption.

In 2013, among 26 states, the District of Columbia, and Puerto Rico, the median prevalence of taking action to reduce sodium intake was 51 percent, ranging from 39 percent to 73 percent, according to a Behavioral Risk Factor Surveillance System survey.

“Making consumers aware of the sodium in foods purchased at restaurants, in the example of New York, and setting targets for sodium in processed and packaged foods, is an ideal way of informing and helping them,” said Creager, director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center. “It helps make the healthy choice the easier choice.”