Policy Progress in Reducing Sodium in the American Diet, 2010–2019

2020 ◽  
Vol 40 (1) ◽  
pp. 407-435
Author(s):  
Aviva A. Musicus ◽  
Vivica I. Kraak ◽  
Sara N. Bleich
Keyword(s):  
Cardiovascular Disease ◽  
Sodium Intake ◽  
The United States ◽  
Dietary Sodium ◽  
Historical Overview ◽  
Sodium Reduction ◽  
The Us ◽  
Packaged Foods ◽  
Excess Sodium ◽  
Evidence For Policy

Most Americans consume dietary sodium exceeding age-specific government-recommended targets of 1,500–2,300 mg/day per person. The majority (71%) of US dietary sodium comes from restaurant and packaged foods. Excess sodium intake contributes to hypertension and cardiovascular disease, which is the leading cause of death in the United States. This review summarizes evidence for policy progress to reduce sodium in the US food supply and the American diet. We provide a historical overview of US sodium-reduction policy (1969–2010), then examine progress toward implementing the 2010 National Academy of Medicine (NAM) sodium report's recommendations (2010–2019). Results suggest that the US Food and Drug Administration made no progress in setting mandatory sodium-reduction standards, industry made some progress in meeting voluntary targets, and other stakeholders made some progress on sodium-reduction actions. Insights from countries that have significantly reduced population sodium intake offer strategies to accelerate US progress toward implementing the NAM sodium-reduction recommendations in the future.

scholarly journals Dietary Sodium Intake and Sodium Density in the United States: Estimates From NHANES 2005–2006 and 2015–2016

2020 ◽  
Vol 33 (9) ◽  
pp. 825-830
Author(s):  
Jiun-Ruey Hu ◽  
Shivani Sahni ◽  
Kenneth J Mukamal ◽  
Courtney L Millar ◽  
Yingfei Wu ◽  
...  
Keyword(s):  
United States ◽  
Odds Ratio ◽  
Sodium Intake ◽  
The United States ◽  
Dietary Sodium ◽  
Health And Nutrition ◽  
Hispanic Adults ◽  
The Us ◽  
The Difference ◽  
Total Sodium

Abstract BACKGROUND In the United States, current guidelines recommend a total sodium intake <2,300 mg/day, a guideline which does not consider kilocalorie intake. However, kilocalorie intake varies substantially by age and sex. We hypothesized that compared with sodium density, total sodium intake overestimates adherence to sodium recommendations, especially in adults consuming fewer kilocalories. METHODS In the National Health and Nutrition Examination Survey (NHANES), we estimated the prevalence of adherence to sodium intake recommendations (<2,300 mg/day) and corresponding sodium density intake (<1.1 mg/kcal = 2,300 mg at 2,100 kcal) by sex, age, race/ethnicity, and kilocalorie level. Adherence estimates were compared between the 2005–2006 (n = 5,060) and 2015–2016 (n = 5,266) survey periods. RESULTS In 2005–2006, 23.1% (95% confidence interval [CI]: 21.5, 24.9) of the US population consumed <2,300 mg of sodium/day, but only 8.5% (CI: 7.6, 9.4) consumed <1.1 mg/kcal in sodium density. In 2015–2016, these figures were 20.9% (CI: 18.8, 23.2) and 5.1% (CI: 4.4, 6.0), respectively. In 2015–2016, compared with 2005–2006, adherence by sodium density decreased more substantially (odds ratio = 0.59; CI: 0.48, 0.72; P < 0.001) than adherence by total sodium consumption (odds ratio = 0.85; CI: 0.73, 0.98; P = 0.03). The difference in adherence between total sodium and sodium density goals was greater among those with lower kilocalorie intake, namely, older adults, women, and Hispanic adults. CONCLUSIONS Adherence estimated by sodium density is substantially less than adherence estimated by total sodium intake, especially among persons with lower kilocalorie intake. Further efforts to achieve population-wide reduction in sodium density intake are urgently needed.

scholarly journals Update on Hypertension and Adaptations for Treatment

2020 ◽  
pp. 18-24 ◽  
Author(s):  
Divya Birudaraju ◽  
Lavanya Cherukuri ◽  
Matthew Budoff
Keyword(s):  
Cardiovascular Disease ◽  
Alcohol Intake ◽  
Sodium Intake ◽  
Adult Population ◽  
Dietary Sodium ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lifestyle Modifications ◽  
The Us ◽  
Ascvd Risk ◽  
Current Guidelines

Hypertension (HTN) affects 46% of the US adult population and plays a major role in cardiovascular disease (CVD). Approximately, there were 90,098 deaths in 2017 primarily attributed to high blood pressure (BP). Recent guidelines recommend screening all adults for HTN. Management of elevated BP substantially reduces the risk of heart failure, stroke, and myocardial infarction. Recommended lifestyle modifications include weight loss for overweight or obese patients, regular exercise, the dietary approached to stop hypertension (DASH) diet, reduced dietary sodium intake, and reduced alcohol intake. Most HTN patients will need at least 2 drugs to control BP. Current guidelines from the ACC and AHA state that a BP level goal of < 130/80mmHg for adults with confirmed HTN and without additional markers of increased atherosclerotic cardiovascular disease (ASCVD) risk may be acceptable.

scholarly journals Dietary Sodium Intake: Scientific Basis for Public Policy

2015 ◽  
Vol 39 (1-3) ◽  
pp. 16-20 ◽  
Author(s):  
Paul K. Whelton
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Clinical Trials ◽  
Observational Studies ◽  
Direct Relationship ◽  
Sodium Intake ◽  
Large Body ◽  
The United States ◽  
Dietary Sodium

Background/Aims: National and international agencies recommend a reduction in dietary sodium intake. However, some have questioned the wisdom of these policies. The goal of this report was to assess the findings and quality of studies that have examined the relationship between dietary sodium and both blood pressure and cardiovascular disease. Methods: Literature review of the available observational studies and randomized controlled trials, including systematic reviews and meta-analyses. Results: A large body of evidence from observational studies and clinical trials documents a direct relationship between dietary sodium intake and the level of blood pressure, especially in persons with a higher level of blood pressure, African-Americans, and those who are older or have comorbidity, including chronic kidney disease. A majority of the available observational reports support the presence of a direct relationship between dietary sodium intake and cardiovascular disease but the quality of the evidence according to most studies is poor. The limited information available from clinical trials is consistent with a beneficial effect of reduced sodium intake on incidence of cardiovascular disease. Conclusions: The scientific underpinning for policies to reduce the usual intake of dietary sodium is strong. In the United States and many other countries, addition of sodium during food processing has led to a very high average intake of dietary sodium, with almost everyone exceeding the recommended goals. National programs utilizing voluntary and mandatory approaches have resulted in a successful reduction in sodium intake. Even a small reduction in sodium consumption is likely to yield sizable improvement in population health. Video Journal Club ‘Cappuccino with Claudio Ronco' at www.karger.com/?doi=368975.

scholarly journals Sodium Levels in Packaged Foods Sold in 14 Latin American and Caribbean Countries: A Food Label Analysis

Nutrients ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 369 ◽  
Author(s):  
JoAnne Arcand ◽  
Adriana Blanco-Metzler ◽  
Karla Benavides Aguilar ◽  
Mary L’Abbe ◽  
Branka Legetic
Keyword(s):  
Latin American ◽  
Sodium Intake ◽  
Cost Effective ◽  
Dietary Sodium ◽  
Sodium Reduction ◽  
Food Label ◽  
Snack Foods ◽  
Adverse Health Effects ◽  
Packaged Foods ◽  
Latin American And Caribbean

Population-wide sodium reduction is a cost-effective approach to address the adverse health effects associated with excess sodium consumption. Latin American and Caribbean (LAC) countries consume excess dietary sodium. Packaged foods are a major contributor to sodium intake and a target for sodium reduction interventions. This study examined sodium levels in 12 categories of packaged foods sold in 14 LAC (n = 16,357). Mean sodium levels and percentiles were examined. Sodium levels were compared to regional sodium reduction targets. In this baseline analysis, 82% of foods met the regional target and 47% met the lower target. The greatest proportion of products meeting the regional target were uncooked pasta and noodles (98%), flavored cookies/crackers (97%), seasonings for sides/main dishes (96%), mayonnaise (94%), and cured/preserved meats (91%). A large proportion of foods met the lower target among uncooked pasta and noodles (88%), cooked pasta and noodles (88%), and meat/fish seasonings (88%). The highest the highest median sodium levels were among condiments (7778 mg/100 g), processed meats (870 mg/100 g), mayonnaise (755 mg/100 g), bread products (458 mg/100 g), cheese (643 mg/100 g), and snack foods (625 mg/100 g). These baseline data suggest that sodium reduction targets may need to be more stringent to enable effective lowering of sodium intake.

Abstract P353: Dietary Sodium Intake and Sodium Density in The United States: Estimates From Nhanes 2005-2006 and 2015-2016

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Jiun-ruey Hu ◽  
Shivani Sahni ◽  
Kenneth J Mukamal ◽  
Courtney Millar ◽  
Yingfei Wu ◽  
...  
Keyword(s):  
Older Adults ◽  
Sodium Intake ◽  
The United States ◽  
Dietary Sodium ◽  
Calorie Intake ◽  
The Us ◽  
Race Ethnicity ◽  
The Difference ◽  
Sodium Consumption ◽  
Total Sodium

Introduction: Current guidelines for sodium reduction focus on total daily sodium consumption (<2300 mg/d) for an intake of 2100 kcal. However, calorie consumption varies substantially. Here, we quantify mean sodium intake, calorie intake, and sodium density across demographic groups in the US and over time. Hypothesis: We hypothesized that, compared to sodium density, total sodium may overestimate adherence to sodium recommendations, especially in older adults. Methods: In the National Health and Nutrition Examination Survey (NHANES), weighted mean sodium and energy intake was estimated in US adults as the average of two 24-hour dietary recalls. Sodium density was calculated as the mg of sodium per 1,000 kcal consumed. The prevalence of adherence to sodium intake (<2300 mg/d) and sodium density (<1.1 mg/kcal) limits was quantified by age group, self-reported sex, self-reported race/ethnicity, Calorie level (<2100 kcal, ≥2100 kcal), and self-reported high blood pressure. Adherence prevalence estimates were compared between 2005-2006 and 2015-2016 survey periods by logistic regression adjusted for age, sex, and race/ethnicity. Methods: In 2015-2016, 24.8% of the US population (mean age 38 yr, 51% female, 12% black) adhered to the recommended <2300 mg/d sodium intake, but only 5.6% achieved the recommended 1.1 mg/kcal sodium density (Table). In 2005-2006, these figures were 26.5% and 8.9%, respectively. While there was no change in adherence by total sodium consumption (P = 0.11), adherence by sodium density was significantly lower in 2015-2016 than 2005-2006 (P < 0.001). The difference in adherence between total sodium and sodium density goals was greater among older adults (≥70 years), women, Hispanic adults, and adults consuming <2100 kcal per day. Conclusions: In 2015-2016, <6% of US adults consumed sodium densities at recommended levels. The prevalence of those achieving these goals is lower compared to 10 years prior. Further efforts to regulate population sodium intake are urgently needed.

Abstract P073: Primary Healthcare Providers’ Attitudes and Counseling Behaviors Related to Dietary Sodium Reduction, DocStyles 2015

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Zerleen S Quader ◽  
Mary E Cogswell ◽  
Sallyann C King ◽  
Robert K Merritt ◽  
Jing Fang
Keyword(s):  
Health Care ◽  
Chronic Kidney Disease ◽  
African American ◽  
Nurse Practitioners ◽  
Sodium Intake ◽  
The United States ◽  
Dietary Sodium ◽  
Diabetic Patients ◽  
Sodium Reduction ◽  
Hypertensive Patients

Introduction: Hypertension is the most common diagnosis given by primary care physicians in the United States. Reductions in blood pressure can be achieved through lifestyle modifications, such as dietary sodium reduction. Previous studies indicate most adults in the United States who receive advice from their physician or health care provider to reduce their sodium take action, but only 13%-25% of all adults and 30%-60% of hypertensive adults report receiving advice. Hypothesis: We hypothesized the majority of providers would report advising patients with hypertension to reduce their sodium intake and agree that most of their patients should reduce their sodium intake. Methods: DocStyles is a national web-based survey of health care providers. In 2015, 465 family/general practitioners, 535 internists, and 251 nurse practitioners were asked questions about their practices related to sodium intake. Results: A majority of providers agreed or strongly agreed with the statement, most of my patients should reduce their sodium intake (78%) and reported advising hypertensive patients (84%), pre-hypertensive patients (69%), and chronic kidney disease patients (71%) to “consume less salt.” Overall fewer providers reported advising diabetic patients (48%) and African-American patients (43%) to consume less salt. However, responses varied significantly by provider type. More than 50% of internists and nurse practitioners reported advising diabetic patients and 51% of nurse practitioners reported advising African-American patients to consume less salt. In addition, 41% of nurse practitioners reported advising all adults to consume less salt compared with 31% of family and general practitioners and 27% of internists. The most commonly reported advice given to patients to consume less salt was to eat less processed food (78%) and to read nutrition labels for sodium content (75%). A majority of providers reported their biggest barrier to reducing dietary sodium intake with hypertensive and pre-hypertensive patients was that “patients are unlikely to comply” (62%). The next most commonly reported barriers were “patients have more immediate health issues” (21%) and “lack of resources for patient education” (19%). Eighteen percent reported “no major barriers”, 14% reported lack of time, and 8% reported “not enough scientific evidence.” Conclusion: Most providers agree their patients should reduce their sodium intake and advise patients with hypertension, pre-hypertension, and chronic kidney disease to reduce their intake. Advice was less likely to be reported for African-American and diabetic patients, who also are at high risk of cardiovascular disease. In conclusion, further effort and educational resources may be required to enable providers to effectively counsel their patients about salt reduction.

scholarly journals Albuminuria intensifies the link between urinary sodium excretion and central pulse pressure in the general population: the Wakuya study

2021 ◽  
Author(s):  
Kaname Tagawa ◽  
Yusuke Tsuru ◽  
Katsumi Yokoi ◽  
Takanori Aonuma ◽  
Junichiro Hashimoto
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Pulse Pressure ◽  
Augmentation Index ◽  
Sodium Intake ◽  
Urinary Sodium Excretion ◽  
Urinary Sodium ◽  
Pressure Amplitude ◽  
Excess Sodium ◽  
Central Pulse Pressure

Abstract Background Central pulse pressure is responsible for the hemodynamics of vital organs, and monitoring this parameter is important for cardiovascular disease prevention. Excess sodium intake and (micro)albuminuria (a manifestation of renal microvascular damage) are known to be strong predictors of cardiovascular disease. We sought to investigate the cross-sectional relationships among dietary sodium intake, albuminuria, and central pulse pressure in a general population cohort. Methods The subjects were 933 apparently healthy adults (mean age, 56 ± 10 years). Radial pressure waveforms were recorded with applanation tonometry to estimate mean arterial pressure, central pulse pressure, forward and backward pressure amplitudes, and augmentation index. The urinary sodium/creatinine and albumin/creatinine ratios were measured in spot urine samples. Results Both the urinary sodium/creatinine and albumin/creatinine ratios were positively correlated with central pulse pressure, even after adjusting for mean arterial pressure (P &lt; 0.001). Moreover, both ratios had a synergistic influence on increasing the central pulse pressure independent of age, sex, estimated glomerular filtration rate, hyperlipidemia, and diabetes (interaction P = 0.04). A similar synergistic influence was found on the forward pressure amplitude, but not on the backward pressure amplitude or augmentation index. The overall results were not altered when the urinary albumin/creatinine ratio was replaced with the existence of chronic kidney disease. Conclusion (Micro)albuminuria strengthens the positive association between urinary sodium excretion and central pulse pressure and systolic forward pressure. Excess sodium intake may magnify the cardiovascular risk by widening the aortic pulsatile pressure, particularly in the presence of concomitant chronic kidney disease.

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

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.

Abstract P183: 20-year Secular Trend of Cardiovascular Disease Comorbidities in the United States, 1997-2016

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Dianjianyi Sun ◽  
Tao Zhou ◽  
Xiang Li ◽  
Yoriko Heianza ◽  
Xiaoyun Shang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Secular Trend ◽  
Adult Population ◽  
The United States ◽  
The Past ◽  
The Us ◽  
Metabolic Conditions ◽  
Respiratory Conditions ◽  
The U.S ◽  
Chronic Comorbidities

Background: Cardiovascular disease (CVD) has been the number one cause of death and disability in the US and globally for decades, and its comorbidity complicates the management of CVD. However, little is known about the secular trend of CVD comorbidities in national representative populations in the last 20 years. Methods: Prevalence of CVD and nine major chronic comorbidities was estimated using data from 1,324,214 adults aged 18 years and older in the National Health Interview Survey (NHIS) from 1997 through 2016, with age-standardized to the U.S. population in the year 2000. Results: CVD prevalence in the US adult population significantly declined in the past twenty years (from 6.6% in 1997 to 5.9% in 2016, P trend <0.01in Figure a). And such trend was shown in women and whites (P trend <0.01), but not in men and blacks (P trend >0.05). We ranked the nine major chronic comorbidities (high to low) in the CVD patients (Figure b.), including (1) hypertension, (2) respiratory conditions, (3) nervous system conditions, (4) digestive conditions, (5) diabetes, (6) cancer, (7) genitourinary conditions, (8) circulatory conditions, and (9) endocrine/nutritional/metabolic conditions. From 1997 to 2016, the prevalence of CVD comorbidities including hypertension (38.8% to 50.2%), digestive conditions (17.0% to 27.1%), diabetes (10.0% to 19.2%), cancer (9.4% to 12.8%), and genitourinary conditions (4.1% to 5.2%) continuingly increased (all P trend <0.01), while respiratory conditions declined (35.9% to 27.6%, P trend <0.01). Similar trends of CVD comorbidities were observed among subgroups stratified by gender or by race. Conclusions: CVD prevalence in the U.S. adults have declined significantly in the past two decades, but rates of CVD comorbidities including hypertension, digestive conditions, diabetes, cancer, and genitourinary conditions increased substantially.

scholarly journals Blood Pressure Effects of Sodium Reduction

Circulation ◽  
2021 ◽  
Vol 143 (16) ◽  
pp. 1542-1567 ◽  
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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