Strategies to Reduce Sodium Intake in the United States (2010) / Chapter Skim
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5 Sodium Intake Estimates for 2003–2006 and Description of Dietary Sources
5 Sodium Intake Estimates for 2003–2006 and Description of Dietary Sources
Pages 119-152
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From page 119... ...
Further, estimated intake has trended upward when compared to the first National Health and Nutrition Examination Survey (NHANES) conducted in 1971–1974.
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From page 120... ...
was established by the IOM ranging from 1,000 to 1,500 mg for persons 2 or more years of age depending on age, and is a value that reflects the recommended average daily intake level based on observed or experimentally determined approximations or estimates of nutrient intake.2 The IOM also established a Tolerable Upper Level of Intake3 (UL) for sodium ranging from 1,500 to 2,300 mg depending upon age, which is the highest daily intake level that is likely to pose no risk of adverse health effects to almost all individuals in the general population (IOM, 2005)
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From page 121... ...
. The strengths of the 24-hour dietary recall include the use of a standardized protocol to quantify the types and amounts of foods consumed over the course of a day, reduced respondent burden, and the provision of valid dietary intake estimates for groups and usual nutrient intake if two or more 24-hour recalls are collected for at least a subsample of the group.
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From page 122... ...
As shown in Table 5-1, sources of dietary sodium include foods, salt added at the table, tap water, and dietary supplements. The sodium content of foods reflects salt added in cooking and food preparation.
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From page 123... ...
provide no indication that there is a decline in sodium intake since the 2003–2006 NHANES. Usual mean total sodium intake from all dietary sources (foods, table salt, tap water, dietary supplements9)
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; sodium intake from food is reported as 5-1.eps Figure a 1-day mean rather than usual intake to be consistent with the data available for other dietary sources. a Includes salt added in cooking and food preparation.
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3,816 3,734 4,000 3,693 mean Sodium Intake (mg/d) 3,280 3,234 3,699 3,500 3,582 3,531 2,796 3,212 3,000 3,122 2,651 median 2,736 2,500 2,201 2,574 2,000 2,144 1,500 2–3 4–8 9–13 14–18 19–30 31–50 51–70 > 70 Age in Years FIGURE 5-2 Usual daily mean and median sodium intake from foods for persons 2 or more years of age.
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From page 126... ...
2,796 3,000 2,50 0 2, 201 2,000 AI AI AI 1,50 0 AI 1,000 500 0 2– 3 4 –8 9 –13 14 –18 Age in Years FIGURE 5-3 Usual mean sodium intake from foods versus Adequate Intake (AI) for children.
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From page 127... ...
, show similar high intake estimates for school-age children. The SNDA-III data reveal a mean sodium intake from foods of 3,402 ± 46.4 mg among public school students on an average school day (Clark and Fox, 2009)
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From page 128... ...
Nine out of 10 adult men have excessive sodium intake. By Sodium Intake Density Sodium intake increases with increased calorie intake (Loria et al., 2001)
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From page 129... ...
NHANES 2003–2004 indicate correlation values for calories-to-sodium intake greater than 0.70 for most groups. Expressing sodium intake per 1,000 calories -- sodium intake density -- allows comparison of intakes without confounding related to associations between total calorie intake and total sodium intake.
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From page 130... ...
Among adolescents and adults, non-Hispanic whites have higher mean sodium intake than non-Hispanic African Americans, and non-Hispanic whites have higher means than Mexican Americans. Since observed differences between racial/ethnic groups may be related to differences in dietary patterns (i.e., the types and amounts of foods consumed)
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From page 131... ...
Mean sodium intake from foods is highest among low-income and higher-income adults ages 19–30 years and higher-income adults ages 31–50 years.
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. Usual mean intake for persons ages 19–30 years, 31–50 years, 98 10 0 99 98 96 10 0 Percent 50 0 Non-Hispanic Adults with Adults 31–50 y Adults 51–70 y Adults > 70 y African Hypertension Americans Race /Ethnicity and Age Groups FIGURE 5-7 Percentage of at-risk populations with mean usual sodium intake from foods exceeding 1,500 mg/d.
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From page 133... ...
. Factors contributing to the sodium content of natural water include the evaporation of ocean spray particles that turn into raindrops, contamination of freshwater aquifers with seawater, road salt that is carried into water supplies by melting snow or rainwater, and the use of home water softeners (Korch, 1986)
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From page 134... ...
For example, in NHANES 2003–2006, the estimated daily contribution from supplements ranged from 0.02 to 540 mg13 among supplement users. Measures Based on Urine Analysis Although estimates of sodium intake based on 24-hour dietary recall methods provide important and useful estimates of intake, they likely underestimate the true total intake of sodium in the population.
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From page 135... ...
Due to heavy respondent burden and other logistical challenges including costs, 24-hour urine collection has not been a component of the NHANES; therefore nationally representative estimates of sodium intake based on this urinary measure are not available from the data set. However, dietary recalls are also considered to be a valid method for assessing sodium intake (Espeland et al., 2001; Reinivuo et al., 2006)
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From page 136... ...
The available 24-hour urinary sodium measures support the NHANES time trend of increasing sodium intake between the early 1970s and the 1990s (Briefel and Johnson, 2004)
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From page 137... ...
Further, different food composition databases have been used to estimate sodium intake over time, there are challenges in estimating sodium from all sources that may have changed over time, and there are likely methodological changes in assessing salt use and food composition data. Sodium Intake Density Over Time As described earlier, expressing sodium intake on the basis of milligrams of sodium per 1,000 calories provides another means of assessing sodium intake over time and between groups.
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From page 138... ...
. The differences in sodium intake that are observed among children and adult men and women disappear to a large degree when expressed as measures of sodium intake density.
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From page 139... ...
In sum, despite the confounding that may occur relative to the observed upward trend in sodium intake since 1971–1974 due to increases in calorie intake and methodological differences among surveys, it is very likely that true increases in sodium intake from foods have occurred. Consistencies across population subgroups in NHANES over five national surveys, consistencies with smaller studies and clinical trials that included urinary sodium
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From page 140... ...
Further, Table 5-7 displays the top five foods that contribute sodium to the diets of persons 2 or more years of age in rank order within each of the 11 major food categories. For example, within the food category of mixed dishes -- the category that is the largest contributor to dietary sodium -- the main contributors (in rank order)
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From page 141... ...
. Finally, Table 5-8 provides an example to illustrate that relative to the food category that is the primary contributor to sodium intake -- mixed dishes -- the sodium in the mixed dish is derived from an array of items added to the dish as part of its preparation.
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From page 142... ...
STRATEGIES TO REDUCE SODIUM INTAKE TABLE 5-7 Top Five Food Contributors to Sodium Intake Within Food Categories for Persons 2 or More Years of Age Percentage of Sodium Contributed in Food Groupa Food Group Food Item Mixed dishes = 44% of Sandwiches (excluding burgers) 35.3 total daily sodium Pizza with meat 12.2 Hamburgers/cheeseburgers 8.5 Mexican entrées 6.9 Pasta dishes, Italian style 6.5 Sum . Meat, meat alternates = Chicken 25.0 15.5% of total Cheese 15.3 Eggs 12.1 Bacon/sausage 10.6 Beef 7.7 Sum 0. Grains = 11.4% of total Bread 21.5 Cold cereal 18.5 Rice 10.9 Pancakes, waffles, French toast 9.6 Crackers 9.0 Sum . Salad (greens)
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From page 143... ...
Currently, as shown in Table 5-9, mean sodium intake density is lowest for foods consumed at home (obtained at the store and prepared or consumed at home) and highest for foods consumed away from home, notably from restaurants and fast food establishments (as defined by NHANES)
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From page 144... ...
Further, in the past two decades, the sodium intake density increased the most for fast food restaurants (see Figure 2-4)
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From page 145... ...
, could also be useful, although currently it is designed primarily for other purposes. The national databases related to food composition -- which include sodium content and are maintained by USDA -- cannot themselves characterize the sodium content of the food supply, but are instead a key component of the process of estimating sodium intake based on dietary recalls from a nationally representative sample of the U.S.
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From page 146... ...
While this does not definitively indicate that there has been an increase in the overall sodium content of the food supply, it is suggestive. More recently, values appear to be leveling off or decreasing slightly.
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From page 147... ...
Currently, about 70 percent of the sodium values in the food composition database used to code and assess sodium in NHANES 2003–2006 are analytical values, 5 percent are from food labels, 11 percent from manufacturers, and 15 percent imputed. Moreover, during the time dietary trends have been measured, the food composition database has been updated and expanded to include more brand names and fast food items as well as a few other restaurant foods.16 Maintaining an up-to-date database on the sodium content of foods is a challenging but essential task.
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From page 148... ...
and food sources of sodium are warranted to better monitor sodium intake and initiatives to reduce sodium. Of particular importance in the case of sodium for food composition tables is the ability to incorporate into such tables the sodium content of menu items offered by the major chain restaurant/foodservice operations.
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From page 149... ...
1997. Dietary meth ods research in the third National Health and Nutrition Examination Survey: Under reporting of energy intake.
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1986. Sodium content of potable water: Dietary significance.
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Journal of the American Dietetic Association 106(1 Supplement)
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