New York City's chain restaurants will soon have to add labels warning diners about the saltiest foods on their menus under a first-in-the-nation initiative approved by the Board of Health.

Beginning Dec. 1, a black-and-white salt shaker icon must appear on menus and menu boards next to meal options with more than the recommended daily limit of 2,300 milligrams of sodium, which equals about a teaspoon of salt.

The regulation affects about 10 percent of offerings at restaurant chains, defined as those with 15 or more locations nationwide. A $200 per-inspection fine will be imposed on eateries that don't comply.

Health Commissioner Dr. Mary Bassett called the salt-content warning a "real step forward for public health." Alluding to efforts launched under former Mayor Michael Bloomberg, Bassett said the city has been a "pioneer" in menu health notices, including calorie-count labeling that the Obama administration is now seeking to introduce nationally.

"We think that a warning label is a very simple, straightforward way to convey necessary information for people to make healthier decisions," Bassett told reporters.

High salt intake can increase the risks of cardiovascular disease, the country's leading cause of death and a condition that disproportionately affects people of color, she said.

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The New York State Restaurant Association denounced the new rule. Its president and chief executive, Melissa Fleischut, called it the "latest in a long litany of superfluous hoops that restaurants here in New York must jump through," especially because federal guidelines on sodium consumption are in the works. The group said it is evaluating its legal options.

The Salt Institute, a trade association, said research shows Americans on average consume a "safe range" of sodium, which it said was defined in one study as between 3,000 and 7,000 mg daily. "This is another example of the government creating policy based on outdated, incorrect sodium guidelines that have been refuted by 10 years of research," the group's president, Lori Roman, said in a statement.

The health board also repealed an informed consent form previously required for an oral suction circumcision ritual practiced in some ultra-Orthodox Jewish communities, which opposed the city requirement. The form, introduced in 2012, showed parents acknowledged the risk of contracting herpes from the ritual in which a religious officiant uses his mouth to remove blood from the incision.

City officials will instead use brochures in English and Yiddish and other outreach efforts to teach parents about the risks associated with the bris ceremony known as metzitzah b'peh.

Since 2000, 18 cases of infant herpes linked to the ritual have been reported. Since the consent rule began, two religious officiants, called mohels, were found to have spread herpes through the practice.


Food outside the sodium limits

New York City's new health warning rules will apply to restaurant chain menu items with more than 2,300 milligrams of sodium. Some examples of choices that exceed that threshold:

Red Robin, Monster Salted Caramel Milkshake: 3,448 mg

Steak 'n Shake, 7 x 7 Steakburger: 4,490 mg

Red Robin, Red's Nantucket Seafood Scatter: 4,211 mg

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Applebee's, Sizzling Skillet Fajitas with Rice, Shrimp: 5,150 mg

Perkins, The Buffalo Wrap: 5,270 mg

Boston Market, St. Louis Style BBQ Ribs, 1/2 Rack: 3,150 mg

Boston Market, Chicken Tortilla Soup w/Toppings: 2,400 mg

Baja Fresh, Carnitas w/ Flour Tortillas: 3,450 mg

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Sbarro, Spaghetti with Chicken Parmagiana: 3,580 mg

Jersey Mike's Subs, Buffalo Chicken Cheesesteak, Giant: 7,790mg

Quiznos, Ultimate Club, Large: 5,820mg

Source: New York City Department of Health and Mental Hygiene