Too much sodium: Stop searching for your lost shaker of salt

About 90% of American adults and children exceed the recommended intake of sodium, according to a CDC report. The health agency reviewed data from 14,728 participants aged ≥2 years in the 2009–2012 National Health and Nutrition Examination Survey (NHANES). Eighty-six percent of hypertensive adults consumed more than 2,300 mg dietary sodium per day – exceeding the 2015–2020 Dietary Guidelines for Americans’ recommendations. Excess sodium intake is a preventable risk factor for hypertension – which affects 29% of adults in the United States – and cardiovascular disease. Hypertension is defined by the CDC as mean systolic blood pressure ≥140 mm, mean diastolic blood pressure ≥90 mm Hg, or self-reported use of antihypertensive medication. Decreasing excessive sodium intake can lower blood pressure to a normal mean systolic blood pressure <120 mm Hg and mean diastolic blood pressure <80 mm Hg.

The nationally representative, multistage survey of non-institutionalized persons in the United States NHANES includes an “in-person examination with a 24-hour dietary recall, and a second 24-hour dietary recall administered by telephone 3-10 days later,” the report says. For children between the ages of 2 to 5 years, dietary intake was reported by a proxy, and for children aged 6 to 11 years, by the participant assisted by a proxy. The study included participants aged ≥2 years that completed two 24-hour dietary recalls, but excluded pregnant women and women whose pregnancy status was unknown, as well as respondents with unreliable dietary recalls, yielding 14,728 respondents eligible for analysis. Most of the participants had at least two complete blood pressure measurements, but for participants with only one, a single measurement was used. Race/ethnicity was categorized as non-Hispanic white (white), non-Hispanic black (black), and Hispanic. Respondents who identified themselves as Mexican-Americans were analyzed separately, but little difference was observed between Mexican-Americans and ‘other Hispanic’ groups.

Most people in the U.S. exceeded recommendations for dietary sodium during the period comprised by the survey, with intake typically higher in persons consuming more kilocalories. Estimated sodium consumed was highest among persons aged 19 to 50 years, and lowest in children aged 2 to 3 years. Men consumed more sodium than women, but the difference between genders was not significant. Adults with hypertension consumed slightly less sodium than people without hypertension, but among groups at higher risk for cardiovascular disease – adults aged ≥51 years, blacks, and adults with pre-hypertension and hypertension – 3 out of 4 nevertheless exceeded the recommended ration.  The findings match previous research on the subject, hinting at the fact that consumption and concentration of sodium in food has remained unchanged in the past 10 years. The main sources of sodium are breads and rolls, deli meats, pizza, poultry, soups, sandwiches, cheese, pasta dishes, meat mixed dishes, such as meatloaf with tomato sauce, and savory snacks.

In summary, all subpopulations exceeded sodium intake recommendations, but adults with hypertension stand to gain the most benefits from decreasing sodium consumption. The fact that this segment had the lowest mean sodium indicate seems to suggest that they have made an effort to lower their sodium intake but could use a bit of extra help. The report remarks that health care providers “can counsel their patients to lower sodium intake through following a healthy dietary pattern. One example is the Dietary Approaches to Stop Hypertension eating plan, which emphasizes fruits, vegetables, and low-fat dairy products.” Additionally, the Institute of Medicine has recommended reducing sodium in the food supply, as excess sodium added to foods during commercial processing and preparation represents the main source of sodium intake in U.S. diets. And sodium reduction is major goal of the Million Hearts initiative, as well as the CDC's Sodium Reduction in Communities Program,  and the National Sodium Reduction Initiative. Finally, there are the U.S. Department of Agriculture Nutrition Standards for school meals and competitive foods, and the Department of Health and Human Services Health and Sustainability Guidelines for Federal Concessions and Vending Operations. For supplements and nutrition supplies check Discount Medical Supplies.

Related: Eat Hearty: Heart and Nutrition