Dietary Reference Intakes for Sodium and Potassium (2019) / Chapter Skim
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11 Sodium Dietary Reference Intakes: Risk Characterization and Special Considerations for Public Health
11 Sodium Dietary Reference Intakes: Risk Characterization and Special Considerations for Public Health
Pages 369-398
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From page 369... ...
are usually established when the evidence is not sufficient to derive Estimated Average Requirements and Recommended Dietary Allowances. The sodium AIs were derived using evidence from the lowest level of sodium intakes evaluated in trials and evidence from the bestdesigned balance study in adults, and were extrapolated to children and adolescents based on sedentary Estimated Energy Requirements (EERs)
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From page 370... ...
Evidence on the effect of sodium reduction on risk of cardiovascular disease, risk of hypertension, and blood pressure was synthesized in order to establish the sodium CDRR. Assessing the public health context of usual sodium intakes of the U.S.
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From page 371... ...
No analyses were identified that estimated usual sodium intake distribution for breastfed infants 0–6 months of age. FITS 2016 = Feeding Infants and Toddlers Study 2016; mg/d = milligrams per day; NHANES = National Health and Nutrition Examination Survey; Not BF = analysis of infants who did not consume breast milk.
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From page 372... ...
The sodium CDRR, therefore, is the intake above which intake reduction is expected to reduce chronic disease risk within an apparently healthy population. For children and adolescents, the sodium CDRRs were extrapolated from the adult value, based on sedentary EERs.
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If sodium intakes are above the CDRR, intake reduction is expected to reduce chronic disease risk within an apparently healthy population. The sodium CDRRs for children and adolescents were extrapolated from the adult CDRR based on sedentary Estimated Energy Requirements.
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If sodium intakes are above the CDRR, intake reduction is expected to reduce chronic disease risk within an apparently healthy population. The sodium CDRRs for children and adolescents were extrapolated from the adult CDRR based on sedentary Estimated Energy Requirements.
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From page 375... ...
and Canadian adults could benefit from sodium reduction, which would be expected to decrease risk of cardiovascular disease in the population. Characterization by Sex and Life Stage On average, males have higher usual intakes of sodium than women, and pregnant and lactating females have higher usual sodium intakes than nonpregnant or lactating females.
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From page 376... ...
376 DIETARY REFERENCE INTAKES FOR SODIUM AND POTASSIUM TABLE 11-5 5th and 50th Percentiles of Usual Sodium Intake Among U.S. and Canadian Adults 19 Years of Age and Older, as Compared to the Sodium Dietary Reference Intake Values AI CDRR 5th Percentile 50th Percentile DRI Group (mg/d)
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If sodium intakes are above the CDRR, intake reduction is expected to reduce chronic disease risk within an apparently healthy population. bPresented as intake (standard error)
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If sodium intakes are above the CDRR, intake reduction is expected to reduce chronic disease risk within an apparently healthy population. SOURCES: CCHS Nutrition 2015 (unpublished)
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AI = Adequate Intake; CDRR = Chronic Disease Risk Reduction Intake; mg/d = milligrams per day. SOURCE: NHANES 2009–2014 (unpublished)
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AI = Adequate Intake; CDRR = Chronic Disease Risk Reduction Intake; mg/d = milligrams per day. SOURCE: NHANES 2009–2014 (unpublished)
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From page 381... ...
Both hypertensive and normotensive population groups in the United States and Canada have sodium intakes that exceed the CDRR; reductions in usual sodium intakes above the CDRR are expected to reduce risk of chronic disease in the apparently healthy population. FIGURE 11-3 Median usual sodium intakes among U.S.
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From page 382... ...
Roles of Sodium in the Food Supply To understand the top contributors of sodium in the diet, the roles of sodium in the food supply are useful to consider. Sodium, typically in the form of sodium chloride (commonly referred to as "salt")
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Salt also helps decrease water activity, which both decreases spoilage and affects the flavor of bread products (Silow et al., 2016)
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The most common forms of phosphates are sodium pyrophosphate and sodium tripolyphosphates. Sodium lactate and sodium diacetate are commonly added to precooked, processed meats along with sodium chloride to reduce or prevent the growth of the food pathogens (Seman et al., 2002)
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In Table 11-8, for instance, cheese is the top contributor to sodium intake, as the analysis disaggregated dairy intake from nondairy food (e.g., mixed dishes)
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Rank Food Categorya Percent Contributionb 1 Yeast breadc 6.2 2 Pizza 5.9 3 All single code sandwichesd 5.7 4 Cold cuts and cured meats 5.4 5 Soups 3.8 6 Burritos and tacos 3.8 7 All savory snackse 3.7 8 Chicken, whole pieces 3.7 9 Cheesef 3.5 10 Eggs and omelets 2.6 aWhat We Eat In America food categories are available at http://www.ars.usda.gov/Services/ docs.htm? docid=23429 (accessed October 22, 2018)
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From page 387... ...
(n = 2,172) Percent Percent Percent Contri- Contri- ContriRank Food Group butiona Food Group butionb Food Group butionc 1 Cheese 8.3 Cheese 9.1 Cheese 8.8 2 Cured meats/ 8.0 Mixed dishes, 6.8 Cured meats/ 6.5 poultry pizza poultry 3 Breads, rolls, 6.4 Cured meats/ 6.5 Mixed dishes, 6.4 tortillas poultry pizza 4 Mixed dishes, 6.2 Breads, rolls, 6.4 Breads, rolls, 6.2 grain-based tortillas tortillas 5 Milk 5.9 Mixed dishes, 6.0 Poultry 5.7 sandwiches 6 Poultry 5.8 Poultry 5.6 Mixed dishes, 5.7 sandwiches 7 Mixed dishes, 4.1 Mixed dishes, 5.5 Mixed dishes, 5.3 sandwiches Mexican grain-based 8 Sweet bakery 4.0 Mixed dishes, 5.4 Mixed dishes, 5.3 products grain-based Mexican 9 Mixed dishes, 3.9 Sweet bakery 4.2 Condiments 4.3 Mexican products and sauces 10 Savory snacks 3.8 Milk 3.6 Mixed dishes, 3.8 meat/poultry/ fish NOTES: Food groups are from the 47 subgroups defined by the What We Eat In America food category classification system.
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From page 388... ...
388 DIETARY REFERENCE INTAKES FOR SODIUM AND POTASSIUM TABLE 11-9 Top 10 Food Categories Contributing to Sodium Intake Among U.S. Persons 19 Years of Age and Older, Ranked by Percent Contribution -- National Health and Nutrition Examination Survey, 2003–2006 (N = 9,490)
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From page 389... ...
The vast majority of the U.S. and Canadian populations consume more sodium than what is recommended by the CDRR, which indicates that cardiovascular disease risk in the population is expected to be reduced with reductions in current sodium intakes.
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. Given the prevalence and effect of hypertension and cardiovascular disease, the public health context for the sodium CDRR is clear: Reductions in sodium intakes above the CDRR are expected to reduce chronic disease risk within the apparently healthy population.
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From page 391... ...
and Canadian adults, a populationbased approach will likely significantly improve public health. The sodium CDRR, therefore, applies to those both with and without existing hypertension in order to lower blood pressure and reduce the incidence of both hypertension and its cardiovascular sequelae.
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From page 392... ...
The sodium AIs, as with all AIs, are intake levels that do not necessarily reflect requirements; rather they are the best estimates for intake levels that are associated with health. The adult sodium AIs established in this report are similar to the values established in the Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005 DRI Report)
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From page 393... ...
However, because sodium has a CDRR that characterizes chronic disease risk reduction with reductions in intake, the absence of a UL may be less problematic for sodium than for a nutrient that has an inverse relationship between intake and chronic disease risk. The expansion of the DRI model now allows for the relationship between nutrient intake and chronic disease risk reduction to be characterized in a separate DRI category.
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From page 394... ...
Moreover, salt preferences develop in childhood and therefore can affect longer-term sodium intakes. The sodium CDRRs for children and adolescents was extrapolated based on EERs for sedentary individuals, rather than being based on reported energy intake.
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2003. Dietary Reference Intakes: Applications in dietary planning.
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From page 396... ...
2005. Dietary Reference Intakes for water, potassium, sodium, chloride, and sulfate.
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From page 397... ...
2018. 2017 ACC/ AHA/AAPA/ABC/ACPM/AGS/APHA/ASH/ASPC/NMA/PCNA guideline for the preven tion, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines.
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