Salt Intake From Packaged Foods Decreasing But Still Too High

MedicalResearch.com Interview with:

Jennifer Poti, PhD Research Assistant Professor Nutritional Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill

Dr. Poti

Jennifer Poti, PhD
Research Assistant Professor
Nutritional Epidemiology
Gillings School of Global Public Health
University of North Carolina at Chapel Hill

MedicalResearch.com: What is the background for this study?

Response: Although strong evidence links excessive sodium intake to hypertension, a leading risk factor for cardiovascular disease, the majority of American children and adults have sodium intake that exceeds the recommended upper limit for daily sodium intake.

To lower sodium intake at the population-level, the Institute of Medicine has recommended that reducing sodium in packaged foods will be essential and has emphasized the need to monitor sodium in the US food supply. However, little is known about whether sodium in packaged foods has changed during the past 15 years.

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Children Eating Too Much Salt At Every Meal

MedicalResearch.com Interview with:

Zerleen S. Quader, MPH CDC

Zerleen S. Quader

Zerleen S. Quader, MPH
CDC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Sodium reduction is considered a key public health strategy to reduce cardiovascular disease nationwide, and this study is the latest in ongoing CDC efforts to monitor U.S. sodium intake.

Eating habits and taste for salt are established early in life by what children eat. Eating too much sodium can set them up for high blood pressure now and health problems later. Previous evidence suggests that one in nine children already has blood pressure above the normal range, and strong evidence has shown that reducing sodium intake reduces blood pressure – and lowering blood pressure lowers the risk of cardiovascular disease among adults. With voluntary efforts already underway by some manufacturers to lower the sodium and added sugar content in some of their products, these findings help provide a baseline to monitor changes in the food industry, as well as sodium intake among U.S. youth.

We examined data from the 2011-2012 National Health and Nutrition Examination Survey (NHANES) to determine sodium intake by major food category, place and eating occasion. We found that average sodium intake among participants was 3,256 mg, and that doesn’t include salt added at the table. On the day of assessment, nearly 90 percent exceeded the upper level of sodium recommended for a healthy diet.

• There were some variations based on age and gender. For example:
o Average intake was highest among high school-aged children
o Girls had significantly lower daily intake than boys (for example, 2,919 mg versus 3,584 mg)
• In addition, we found that ten types of food make up nearly half of youth sodium intake nationwide, including pizza, bread, lunch meats and snack foods.

We also analyzed where the foods were obtained and found that approximately 58 percent of sodium comes from store foods, 16 percent from fast food and pizza restaurants and 10 percent from school cafeteria foods. And when we looked at occasion, we discovered that 39 percent of sodium intake was consumed at dinner, 31 percent at lunch, 16 percent from snacks and 14 percent from breakfast.
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Lower Salt Intake Linked To Decreased Blood Pressure, Heart Disease and Mortality

MedicalResearch.com Interview with:

Nancy Cook ScD Professor of Medicine, Harvard Medical School Professor in the Department of Epidemiology Harvard T.H. Chan School Public Health Brigham & Women’s Hospital Division of Preventive Medicine Boston, MA 0221

Dr. Nancy Cook

Nancy Cook ScD
Professor of Medicine, Harvard Medical School
Professor in the Department of Epidemiology
Harvard T.H. Chan School Public Health
Brigham & Women’s Hospital Division of Preventive Medicine
Boston, MA 02215

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The association of sodium intake with later mortality has been controversial. While there is a well-accepted effect on blood pressure, the effects of sodium on later cardiovascular disease, and particularly mortality, have been subject to dispute. While the adverse effects of high sodium are now widely accepted, effects at lower levels of sodium intake are less clear. Some recent studies have found a J-shaped relationship, with increased disease rates among those consuming lower levels of sodium, contrary to the effects on blood pressure.

In contrast, we found a direct linear relationship of usual intake of sodium with later mortality over 20 years of follow-up. Those with the lowest sodium intake experienced the lowest mortality. Our measure of intake was based on the average over 1-3 years of several measures of 24hr urine sodium excretion, the gold standard of sodium measurement. This is much more precise than measurements based on a single 24hr sodium excretion or especially on a spot urine sample, which is used in many publications that found the J-shaped curve. Our data were assessed in a healthy cohort of men and women without hypertension or cardiovascular disease, so had less potential bias due to these factors. We thus believe that our results showing the lowest mortality among those consuming the lowest levels of sodium are more accurate.

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Young Children May Acquire A Taste For Salt From Common Foods In Infancy

Joyce Maalouf MS MPH Nutrition Epidemiologist CDC, AtlantaMedicalResearch.com Interview with:
Joyce Maalouf MS MPH
Nutrition Epidemiologist
CDC, Atlanta

Medical Research: What is the background for this study? What are the main findings?

Response: Although significant research shows U.S. children are eating too much sodium, data on the top dietary sources contributing to that intake is limited – particularly among babies and toddlers. This study identifies the primary sources of dietary sodium consumed by children from birth to 24-months-old, as well as differences in intake and food source broken down by demographic characteristics including age, gender and race/ethnicity.

Overall, our research revealed that after the age of six months, more than 70 percent of sodium intake comes from foods other than breast milk and infant formula. Commercial baby foods, soups and pasta mixed dishes are top sodium contributors for U.S. infants 6 to 11.9 months, while soups, cheese, pasta mixed dishes and frankfurters and sausages are key contributors among toddlers aged 12 up to 24 months. Top sodium sources varied by race/ethnicity within age groups, suggesting that for sodium reduction to be effective, it needs to occur across a wide variety of foods.

In addition, we found that non-Hispanic black toddlers ate more sodium than non-Hispanic white and Mexican-American children. Average sodium intake increased almost 9-fold from children under six months to those between one and two-years-old, while average energy intake only doubled. This suggests that, during the first two years of life, U.S. children increasingly consume sodium-rich foods.

To determine these findings, we examined eight years of data encompassing more than 2,900 participants between birth and two-years-old. The information was pulled from the nationwide NHANES What We Eat in America survey between 2003 and 2010.

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Sodium Content In Commercial Foods Remains High and Variable

Jaspreet Ahuja, Nutritionist USDA, Agricultural Research Service Nutrient Data Laboratory Beltsville, MD 20705MedicalResearch.com Interview with: Jaspreet Ahuja, Nutritionist
USDA, Agricultural Research Service
Nutrient Data Laboratory
Beltsville, MD 20705

MedicalResearch: What is the background for this study? What are the main findings?

Response: Most sodium in the U.S. diet comes from commercially processed and restaurant foods. Sodium reduction in these foods is key to several recent public health efforts. In this paper, we provide an overview of a program led by Nutrient Data Laboratory, USDA, in partnership with CDC and FDA to monitor sodium contents in commercially processed and restaurant foods in United States.

We track about 125 highly consumed, sodium-contributing foods, termed “Sentinel Foods” annually using information from food manufacturers and periodically by nationwide sampling and laboratory analyses. In addition, we monitor over 1,100 other commercially processed and restaurant food items, termed “Priority-2 Foods,” biennially using information from food manufacturers. These foods serve as indicators for assessing changes in the sodium content of commercially processed and restaurant foods in the U.S. In addition to sodium, we are monitoring related nutrients (potassium, total dietary fiber, total and saturated fat, total sugar) because their levels may change when manufacturers and restaurants reformulate their products to reduce their sodium content.

We sampled all Sentinel Foods nationwide and reviewed all Priority-2 Foods in 2010–2013 to determine baseline sodium concentrations. The results of sodium reduction efforts, based on re-sampling of the Sentinel Foods or re-review of P2Fs, will become available in 2015 on our website. The updated data are also released in USDA food composition databases, National Nutrient Database for Standard Reference and Food and Nutrient Database for Dietary Studies.

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More Medical Advice May Help Patients Reduce Salt Intake

Dr. Sandra L. Jackson, Ph.D., M.P.H Epidemic intelligence service fellow Centers for Disease Control and Prevention, Chamblee, GAMedicalResearch.com Interview with:
Dr. Sandra L. Jackson, Ph.D., M.P.H
Epidemic intelligence service fellow
Centers for Disease Control and Prevention, Chamblee, GA

Medical Research: What is the background for this study? What are the main findings?

Dr. Jackson: With more than 90 percent of U.S. adults exceeding recommended sodium intake levels, healthcare providers can play a key role in counseling patients on the importance of limiting salt in the diet.

To assess the impact of medical advice on an individual’s efforts to reduce sodium intake, CDC researchers examined self-reported telephone survey information from nearly 174,000 U.S. adults. Overall, more than half of the respondents reported watching or reducing their sodium intake in 2013 – but less than one quarter (23 percent) said they received advice from a doctor or healthcare professional about sodium reduction. Of those that received the medical advice, 82 percent reported taking action to limit their sodium intake. In comparison, only 44 percent of respondents who reported not receiving medical advice said they took steps to reduce sodium.

The substantial proportion of patients who are not receiving medical advice (77%), according to these findings, reveals a missed opportunity to reduce sodium intake, particularly among groups that have a higher risk of developing cardiovascular disease. This includes African Americans, and those with high blood pressure, diabetes or chronic kidney disease.

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Sodium Reduction Not Linked To Higher Fasting Glucose Concentrations

Sheena M. Patel, MPH, ORISE, Fellow Division for Heart Disease and Stroke Prevention CDCMedicalResearch.com Interview with:
Sheena M. Patel, MPH, ORISE, Fellow
Division for Heart Disease and Stroke Prevention
CDC

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Patel: Although significant evidence reveals reduced sodium intake lowers blood pressure, some studies report that sodium reduction could have a negative impact on insulin resistance and glucose tolerance. As a result, we conducted a comprehensive meta-analysis of intervention studies to examine the effect of sodium reduction on glucose tolerance and provide direction for future research.

Overall, our research found sodium reduction did not lead to higher average fasting glucose concentrations, a measure of insulin resistance. This suggests that the current recommendations to reduce sodium intake are unlikely to cause harm related to hyperglycemia or insulin resistance. It’s important to note that, in some cases, sodium reduction was associated with higher average insulin concentrations. However, this finding varied significantly across studies, suggesting caution in interpreting this result.

To determine these findings, we reviewed previously published randomized and non-randomized prospective intervention trials. In randomized trials, people have an equal chance of being in each group examined. The data was pulled from five databases with research spanning from January 1950 to August 2014 and included 38 trials.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Patel: This study is meaningful because it suggests short-term large reductions in sodium intake might not affect fasting glucose concentrations, a measure of insulin resistance.  These findings can help clinicians, patients and public health representatives focus efforts as needed.

Due to the overwhelming evidence in favor of reducing sodium intake, CDC continues to support sodium reduction as an achievable and effective public health strategy to lower blood pressure and improve heart health nationwide.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Patel: This meta-analysis revealed no evidence that, in trials with a short intervention and large reductions in sodium, circulating glucose concentrations differed between groups. Further research could more rigorously examine the impact of sodium reduction on glucose tolerance, including ensuring that participants are randomly assigned to interventions, test longer intervention durations, incorporate sodium intake levels relevant to population reduction initiatives, and examine the longer-term measures of glucose tolerance, e.g., glycated hemoglobin.

Citation:

Dietary Sodium Reduction Does Not Affect Circulating Glucose Concentrations in Fasting Children or Adults: Findings from a Systematic Review and Meta-Analysis

Sheena M Patel, Paul Cobb, Sharon Saydah, Xuanping Zhang, Janet M de Jesus, and Mary E Cogswell

Nutr. 2015 jn.114.195982; first published online January 21, 2015. doi:10.3945/jn.114.195982

MedicalResearch.com Interview with:, & Sheena M. Patel, MPH, ORISE, Fellow (2015). Sodium Reduction Not Linked To Higher Fasting Glucose Concentrations MedicalResearch.com

Reduced Sodium Intake May Improve Heart Failure Prognosis

MedicalResearch.com Interview with:
Dr. Eloisa Colin-Ramirez, BSc, PhD
and
Justin A. Ezekowitz, MBBCh MSc
Associate Professor, University of Alberta
Co-Director, Canadian VIGOUR Centre
Director, Heart Function Clinic
Cardiologist, Mazankowski Alberta Heart Institute

Medical Research: What is the background for this study? What are the main findings?

Response: The SODIUM-HF study is a randomized control trial on sodium restriction in patients with chronic heart failure (HF). Sodium restriction has been broadly recommended as part of the self-care strategies in heart failure yet is based on little high-quality evidence. This study reports the results of the pilot SODIUM-HF trial in 38 patients with chronic HF. Nineteen patients were prescribed a low sodium containing diet (1500 mg/day) and 19 a moderate sodium containing diet (2300 mg/day). Both interventions were based on a structured and individualized meal plan to achieve the targeted sodium intake, and all patients were followed for 6 months with monthly phone call to reinforce adherence to the diet.

We found a meaningful reduction in sodium intake to less than 1500 mg/day at 6 months in both groups. Additionally, we observed that patients that achieved a sodium intake less than 1500 mg/day at 6 months of follow-up had reduced BNP levels, a biomarker of volume overload and surrogate prognostic marker in heart failure, and increased overall and clinical scores of the Kansas City Cardiomyopathy Questionnaire, compared to those with a sodium intake greater than 1500 mg/day.

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Too Little and Too Much Salt Associated with Increased Mortality

MedicalResearch.com Interview with:
Niels Graudal, MD, DrMSc
Senior Consultant
Department of Internal medicine/Infectious Medicine/Rheumatology IR4242
Copenhagen University Hospital, Rigshospitalet
Denmark

Dr. Graudal: There are no studies, which show what happens with the risk of cardiovascular death or mortality if you change your sodium intake. Our study shows the association of sodium intake as it is with cardiovascular disease and mortality, which is only the second best way to consider the problem, but as the best way does not exist we have accepted this approach. There have been two different assumptions concerning the risks of sodium intake. One is that there is an increasing risk of heart disease, stroke and death of salt intake above 2300 mg, and one is that salt is not dangerous at all. Our study shows that both positions partially may be true, as a salt intake above 4900 mg is associated with increased risk of cardiovascular disease and mortality, whereas the present normal salt intake of most of the world’s populations between 2300 mg and 4900 mg is not associated with any increased risks. In addition our study shows that a low sodium intake below 2300 mg is also associated with increased risk of cardiovascular disease and death.

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Restaurant Meals: Almost a Full Day’s Worth of Calories, Fats, and Sodium

MedicalResearch.com eInterview with:

Mary Scourboutakos
PhD student at the University of Toronto

Mary R. L’Abbe, PhD
Earle W. McHenry Professor, and Chair, Department of Nutritional Sciences
Faculty of Medicine, University of Toronto
FitzGerald Building, 150 College Street, Rm 315
Toronto, ON, Canada M5S 3E2

MedicalResearch.com: What are the main findings of the study?

Answer: We found that chain restaurant meals on average contained half a day’s worth of calories, almost a full day’s worth of fat and saturated fat, and more than a day’s worth of sodium.

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