Receiving Advice from a Health Professional and Action Taken to Reduce Dietary Sodium Intake among Adults

Abstract Objective: Population reductions in sodium intake could prevent hypertension, and current guidelines recommend that clinicians advise patients to reduce intake. This study aimed to estimate the prevalence of taking action and receiving advice from a health professional to reduce sodium intake in 10 US jurisdictions, including the first-ever data in New York state and Guam. Design: weighted prevalence and 95% confidence intervals (CI) overall and by location, demographic group, health status, and receipt of provider advice using self-reported data from the 2017 Behavioral Risk Factor Surveillance System optional sodium module Setting: seven states, the District of Columbia, Puerto Rico, and Guam Participants: adults aged ≥18 years Results: Overall, 53.6% (CI: 52.7, 54.5) of adults reported taking action to reduce sodium intake, including 54.8% (CI: 52.8, 56.7) in New York and 61.2% (CI: 57.6, 64.7) in Guam. Prevalence varied by demographic and health characteristics and was higher among adults who reported having hypertension (72.5%; CI: 71.2, 73.7) vs. those who did not report having hypertension (43.9%; CI: 42.7, 45.0). Among those who reported receiving sodium reduction advice from a health professional, 82.6% (CI: 81.3, 83.9) reported action vs. 44.4% (CI: 43.4, 45.5) among those who did not receive advice. However, only 24.0% (CI: 23.3, 24.7) of adults reported receiving advice from a health professional to reduce sodium intake. Conclusions: The majority of adults report taking action to reduce sodium intake. Results highlight an opportunity to increase sodium reduction advice from health professionals during clinical visits to better align with existing guidelines.

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Mapping Dietary Sodium Reduction Policies and Initiatives in the Region of the Americas

Current Developments in Nutrition ◽

10.1093/cdn/nzaa064_004 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1714-1714

Author(s):

Nadia Flexner ◽

Mary L'Abbé ◽

Barbara Legowski ◽

Ruben Grajeda Toledo

Keyword(s):

Sodium Intake ◽

Cost Effective ◽

Dietary Sodium ◽

World Health ◽

Significant Advance ◽

Relative Reduction ◽

Sodium Reduction ◽

Pan American ◽

Reduce Sodium Intake ◽

Health Organization

Abstract Objectives To map existing country policies addressing population dietary sodium reduction in the Americas; to identify policy gaps in the region following what is outlined in the World Health Organization (WHO) “Best Buys” most cost-effective recommendations for the prevention and control of diet-related noncommunicable diseases (NCDs); and to discuss priorities for future work in the Region. Methods This study used mixed methods to analyze data from 34 countries. Data were collected through a structured review, of mostly national official sources, to identify current policies in place to reduce population sodium intake. Also, responses from the last Pan American Health Organization (PAHO) online Survey on National Initiatives for Sodium Reduction in the Americas were included. Finally, country profiles were prepared and sent to each country's Public Health Agency for validation and comments. Results Almost all countries (n = 23/34) had a recommendation to reduce salt intake included in policies related to NCDs. Only six countries had specific and comprehensive policies to reduce sodium intake, and only one of them was a National Law. Adoption of the WHO “Best Buys” in national policies included: reformulation of food products with voluntary (n = 9/34) and mandatory targets (n = 2/34); establishment of a supportive environment in public institutions (n = 14/34); and implementation of front-of-pack labelling (n = 5/34). Some countries have implemented regulations restricting marketing of foods high in sodium to children (n = 5/34); nutritional labelling that includes sodium content, either voluntary (n = 9/34) or mandatory (n = 10/34); and no country has yet implemented taxes on high sodium foods. Conclusions In recent years, there has been a significant advance in policies to reduce sodium intake in the Region of the Americas. However, this review identified that the level of implementation in practice is complex to assess and quite heterogeneous. Reducing sodium consumption is a cost-effective intervention that can save many lives, by preventing and reducing the burden of diet related NCD's. Therefore, a further call to action is needed for governments to accelerate efforts in order to meet the 2025 global target of a 30% relative reduction in mean population intake of sodium. Funding Sources Pan American Health Organization (PAHO/WHO).

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Cigarette Smoking Among Adults--New York State 2000: Tobacco Use, Cessation, and Exposure to Second-Hand Smoke among New York State Adults: Behavioral Risk Factor Surveillance System

PsycEXTRA Dataset ◽

10.1037/e602682007-001 ◽

2003 ◽

Keyword(s):

New York ◽

Surveillance System ◽

New York State ◽

Second Hand Smoke ◽

Behavioral Risk ◽

Behavioral Risk Factor ◽

Tobacco Use Cessation ◽

York State ◽

Behavioral Risk Factor Surveillance ◽

Risk Factor Surveillance

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Knowledge, perception, and practice related to sodium intake among Malaysian adults: findings from the Malaysian Community Salt Study (MyCoSS)

Journal of Health Population and Nutrition ◽

10.1186/s41043-021-00231-4 ◽

2021 ◽

Vol 40 (S1) ◽

Author(s):

Siew Man Cheong ◽

Rashidah Ambak ◽

Fatimah Othman ◽

Feng J. He ◽

Ruhaya Salleh ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Sodium Intake ◽

Dietary Sodium ◽

Health Concern ◽

Sodium Reduction ◽

Salt Reduction ◽

Complex Sample ◽

Health Organization

Abstract Background Excessive intake of sodium is a major public health concern. Information on knowledge, perception, and practice (KPP) related to sodium intake in Malaysia is important for the development of an effective salt reduction strategy. This study aimed to investigate the KPP related to sodium intake among Malaysian adults and to determine associations between KPP and dietary sodium intake. Methods Data were obtained from Malaysian Community Salt Survey (MyCoSS) which is a nationally representative survey with proportionate stratified cluster sampling design. A pre-tested face-to-face questionnaire was used to collect information on socio-demographic background, and questions from the World Health Organization/Pan American Health Organization were adapted to assess the KPP related to sodium intake. Dietary sodium intake was determined using single 24-h urinary sodium excretion. Respondents were categorized into two categories: normal dietary sodium intake (< 2000 mg) and excessive dietary sodium intake (≥ 2000 mg). Out of 1440 respondents that were selected to participate, 1047 respondents completed the questionnaire and 798 of them provided valid urine samples. Factors associated with excessive dietary sodium intake were analyzed using complex sample logistic regression analysis. Results Majority of the respondents knew that excessive sodium intake could cause health problems (86.2%) and more than half of them (61.8%) perceived that they consume just the right amount of sodium. Overall, complex sample logistic regression analysis revealed that excessive dietary sodium intake was not significantly associated with KPP related to sodium intake among respondents (P > 0.05). Conclusion The absence of significant associations between KPP and excessive dietary sodium intake suggests that salt reduction strategies should focus on sodium reduction education includes measuring actual dietary sodium intake and educating the public about the source of sodium. In addition, the relationship between the authority and food industry in food reformulation needs to be strengthened for effective dietary sodium reduction in Malaysia.

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Abstract 13567: Variability in Reported Post-percutaneous Coronary Intervention Mortality Among Physicians Practicing at Multiple Sites in New York State

Circulation ◽

10.1161/circ.142.suppl_3.13567 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Nancy Yang ◽

Peter W Groeneveld ◽

Sameed Ahmed M Khatana ◽

Jay S Giri ◽

Alexander C Fanaroff ◽

...

Keyword(s):

New York ◽

Percutaneous Coronary Intervention ◽

New York State ◽

Rare Event ◽

Coronary Intervention ◽

Site Specific ◽

York State ◽

Individual Site ◽

Percutaneous Coronary ◽

Reported Data

Introduction: New York State (NYS) publicly reports physician-level post-percutaneous coronary intervention (PCI) mortality at each individual site they practice, to empower patients to make informed decisions. Given that mortality is a rare event and some sites have low case volumes, we hypothesized that the reported data at each site for physicians practicing at multiple sites is highly unstable and thus misleading for patients. In this study, we examined variation in site-specific risk-adjusted mortality rates (RAMR) for physicians practicing at multiple sites in NYS. Methods: This study uses publicly reported 30-day physician-level RAMR for all PCI performed in NYS between 2014 and 2016. We obtained the site-specific RAMR (ssRAMR) at each hospital where the physician performed PCI, and overall mean RAMR (mRAMR) for the physician. We excluded physicians who performed PCI at only one hospital. We identified outliers for mRAMR and maximum ssRAMR if values were greater than the 95 th percentile for each measure and plotted the outliers. Results: Between 2014 and 2016, 142,853 PCI procedures were performed by 373 physicians at 61 hospitals. Among 207 (55.5%) physicians practicing at multiple sites who performed 82,075 PCI (57.5%), the median mRAMR was 1.11% (IQR 0.66-1.60%, range 0-5.33%) and the median ssRAMR was 0.52% (IQR 0-1.53%, range 0-47.69%). Among the 11 physicians classified as ssRAMR outliers, only 3 (27.2%) physicians were also classified as an mRAMR outlier. Conclusion: We found that the individual ssRAMRs reported for a physician practicing at multiple hospitals is highly variable, and that mRAMR and ssRAMR outlier status are not consistent with each other. Thus, we believe public reporting of ssRAMR in NYS does not adequately reflect the quality of care delivered by physicians performing PCI. Figure: mRAMR and ssRAMR among maximum ssRAMR outliers. Each letter (A-K) represents a separate outlier physician.

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Blood Pressure Effects of Sodium Reduction

Circulation ◽

10.1161/circulationaha.120.050371 ◽

2021 ◽

Vol 143 (16) ◽

pp. 1542-1567 ◽

Cited By ~ 2

Author(s):

Tommaso Filippini ◽

Marcella Malavolti ◽

Paul K. Whelton ◽

Androniki Naska ◽

Nicola Orsini ◽

...

Keyword(s):

Blood Pressure ◽

Clinical Trials ◽

Linear Relationship ◽

Dose Response ◽

Sodium Intake ◽

Experimental Studies ◽

Dietary Sodium ◽

Response Analysis ◽

Sodium Reduction

Background: The relationship between dietary sodium intake and blood pressure (BP) has been tested in clinical trials and nonexperimental human studies, indicating a direct association. The exact shape of the dose–response relationship has been difficult to assess in clinical trials because of the lack of random-effects dose–response statistical models that can include 2-arm comparisons. Methods: After performing a comprehensive literature search for experimental studies that investigated the BP effects of changes in dietary sodium intake, we conducted a dose–response meta-analysis using the new 1-stage cubic spline mixed-effects model. We included trials with at least 4 weeks of follow-up; 24-hour urinary sodium excretion measurements; sodium manipulation through dietary change or supplementation, or both; and measurements of systolic and diastolic BP at the beginning and end of treatment. Results: We identified 85 eligible trials with sodium intake ranging from 0.4 to 7.6 g/d and follow-up from 4 weeks to 36 months. The trials were conducted in participants with hypertension (n=65), without hypertension (n=11), or a combination (n=9). Overall, the pooled data were compatible with an approximately linear relationship between achieved sodium intake and mean systolic as well as diastolic BP, with no indication of a flattening of the curve at either the lowest or highest levels of sodium exposure. Results were similar for participants with or without hypertension, but the former group showed a steeper decrease in BP after sodium reduction. Intervention duration (≥12 weeks versus 4 to 11 weeks), type of study design (parallel or crossover), use of antihypertensive medication, and participants’ sex had little influence on the BP effects of sodium reduction. Additional analyses based on the BP effect of difference in sodium exposure between study arms at the end of the trial confirmed the results on the basis of achieved sodium intake. Conclusions: In this dose–response analysis of sodium reduction in clinical trials, we identified an approximately linear relationship between sodium intake and reduction in both systolic and diastolic BP across the entire range of dietary sodium exposure. Although this occurred independently of baseline BP, the effect of sodium reduction on level of BP was more pronounced in participants with a higher BP level.

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Knowledge, Attitudes, and Behaviors Related to Sodium Intake and Reduction Among Adult Consumers in the United States

American Journal of Health Promotion ◽

10.4278/ajhp.150102-quan-650 ◽

2016 ◽

Vol 31 (1) ◽

pp. 68-75 ◽

Cited By ~ 15

Author(s):

Deesha Patel ◽

Mary E. Cogswell ◽

Katherine John ◽

Stephanie Creel ◽

Carma Ayala

Keyword(s):

United States ◽

Health Professional ◽

Sodium Intake ◽

The United States ◽

Cross Sectional Survey ◽

Professional Advice ◽

Attitudes And Behaviors ◽

Reduce Sodium Intake ◽

And Behaviors ◽

Respondent Characteristics

Purpose. To describe the prevalence and determinants of sodium-related knowledge, attitudes, and behaviors among U.S. adults Design. A cross-sectional survey was used. Setting. The study was set in the United States in 2012. Subjects. Participants were 6122 U.S. adults. Measures. Sodium-related knowledge, attitudes, and behaviors were measured. Analysis. Chi-squared tests were used to determine differences in sodium-related knowledge, attitude, and behaviors by respondent characteristics; multiple logistic regression was used to examine associations between selected respondent characteristics and health professional advice, reported action, or knowledge, attitudes, and behaviors (adjusted for all other respondent characteristics). Results. About three-fourths of respondents answered eating too much sodium is “somewhat” or “very” harmful to their health. Twenty-six percent reported receiving health professional advice, and 45% reported taking action to reduce their sodium intake. The prevalence of reported action was highest among adults receiving advice, those with hypertension, blacks, and those aged ≥65 years. Sixty-two percent who reported action agreed that most of their sodium comes from processed or restaurant foods. Of those reporting action, the most common tactics to reduce sodium intake were checking nutrition labels, using other spices than salt, and choosing low-sodium foods; requesting lower-sodium options when eating out was the least common tactic. Conclusion. Results suggest almost half of adults overall and the vast majority of those receiving health professional advice are taking some action to watch or reduce sodium intake. Although a substantial proportion report using recommended tactics to lower intake, many are not using the most effective tactics. In order to reach the general population, health communication messages could be simpler and focus on the most effective tactics to reduce sodium intake. Furthermore, health professionals can help reduce sodium intake by discussing the benefits of sodium reduction and tactics to do so, regardless of a hypertension diagnosis.

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New York State Physicians: Characteristics and Distribution in Health Professional Shortage Areas

Journal of Urban Health ◽

10.1007/s11524-006-9129-3 ◽

2006 ◽

Vol 84 (2) ◽

pp. 307-309 ◽

Cited By ~ 5

Author(s):

Neil S. Calman ◽

Diane Hauser ◽

Gaetano Forte ◽

Tracey Continelli

Keyword(s):

New York ◽

Health Professional ◽

New York State ◽

York State

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Developing a Web-based dietary sodium screening tool for personalized assessment and feedback

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2013-0322 ◽

2014 ◽

Vol 39 (3) ◽

pp. 413-414 ◽

Cited By ~ 12

Author(s):

JoAnne Arcand ◽

Kasim Abdulaziz ◽

Carol Bennett ◽

Mary R. L’Abbé ◽

Douglas G. Manuel

Keyword(s):

Screening Tool ◽

Sodium Intake ◽

Public Health Problem ◽

Canadian Community Health Survey ◽

Dietary Sodium ◽

Sodium Reduction ◽

Important Public Health Problem ◽

Web Based ◽

University Of Toronto ◽

Sodium Consumption

Dietary sodium reduction is commonly used in the treatment of hypertension, heart and liver failure, and chronic kidney disease. Sodium reduction is also an important public health problem since most of the Canadian population consumes sodium in excess of their daily requirements. Lack of awareness about the amount of sodium consumed and the sources of sodium in diet is common, and undoubtedly a major contributor to excess sodium consumption. There are few known tools available to screen and provide personalized information about sodium in the diet. Therefore, we developed a Web-based sodium intake screening tool called the Salt Calculator ( www.projectbiglife.ca ), which is publicly available for individuals to assess the amount and sources of sodium in their diet. The Calculator contains 23 questions focusing on restaurant foods, packaged foods, and added salt. Questions were developed using sodium consumption data from the Canadian Community Health Survey cycle 2.2 and up-to-date information on sodium levels in packaged and restaurant food databases from the University of Toronto. The Calculator translates existing knowledge about dietary sodium into a tool that can be accessed by the public as well as integrated into clinical practice to address the high levels of sodium presently in the Canadian diet.

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Actions to Control High Blood Pressure among Hypertensive Adults in Texas Counties along the Mexico Border: Texas BRFSS, 2007

Public Health Reports ◽

10.1177/003335491212700206 ◽

2012 ◽

Vol 127 (2) ◽

pp. 173-185 ◽

Cited By ~ 1

Author(s):

Carma Ayala ◽

Jing Fang ◽

Luis Escobedo ◽

Stephen Pan ◽

Hector G. Balcazar ◽

...

Keyword(s):

Blood Pressure ◽

Antihypertensive Medication ◽

Behavioral Risk ◽

Lifestyle Modifications ◽

Control Blood Pressure ◽

Antihypertensive Medications ◽

Hispanic People ◽

Mexico Border ◽

Reported Data ◽

Taking Action

Objectives. We examined the prevalence of actions taken to control blood pressure as measured by taking antihypertensive medication or making lifestyle modifications among hypertensive adults residing along the Texas/Mexico border. Methods. We used self-reported data from the 2007 Texas Behavioral Risk Factor Surveillance System, with oversampling of border counties. We calculated the age-standardized prevalence of actions taken to control hypertension by selected characteristics. Results. In analyses that combined ethnicity with predominant language spoken, those least likely to take any action to control their blood pressure—either by taking an antihypertensive medication or by making any of four lifestyle modifications—were Spanish-speaking Hispanic people (83.2% ± 2.7% standard error [SE]), with English-speaking non-Hispanic people (88.9% ± 0.8% SE) having the highest prevalence of taking action to control blood pressure. When analyzed by type of medical category, uninsured Hispanic people (63.8% ± 4.8% SE) had the lowest prevalence of taking action to control their blood pressure compared with uninsured non-Hispanic people (75.4% ± 4.7% SE). Nonborder Texas residents with hypertension were more likely to take antihypertensive medications (78.4% ± 1.0% SE) than border county residents with hypertension (70.7% ± 2.0% SE). Conclusions. Public health efforts must be undertaken to improve the control of hypertension among residents of Texas counties along the Mexico border, particularly for uninsured Hispanic people.

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