Study finds high sodium intake common in both adults and children.
The 2015-2020 Dietary Guidelines for Americans recommend consuming less than 2,300 mg of sodium per day for people over 14 years old, and less for ages 2-13. To analyze the current prevalence of excess sodium intake among Americans overall, and among hypertensive patients, the CDC utilized the 2009-2012 National Health and Nutrition Examination Survey (NHANES). NHANES is a national, multistage survey of United States residents. The survey consists of an in-person exam with a 24-hour dietary journal, and a second 24-hour dietary journal over the phone 3-10 days later.
This cross-sectional study aimed to assess the prevalence of excess sodium intake among Americans. The study included participants over 2 years old who completed two 24-hour dietary journals, but excluded pregnant women and respondents with unreliable dietary journals, resulting in 14,728 individuals eligible for analysis. Hypertension was defined as mean systolic blood pressure ≥ 140 mmHg and mean diastolic blood pressure ≥ 90 mmHg, or self-reported use of blood pressure medications. Prehypertension is defined as a mean systolic blood pressure of 120-139 mmHg and mean diastolic blood pressure of 80-89 mmHg. Blood pressure values were determined using an average of up to three brachial blood pressure values. Race/ethnicity was defined as either non-Hispanic white, non-Hispanic black, or Hispanic.
Estimated mean daily sodium intake and caloric intake was calculated, as well as sodium density (mg of sodium per 1,000 kilocalories consumed). Software was used to account for day-to-day variation in sodium intake to estimate usual sodium intake from two 24-hour dietary journals. The proportion of people with excess sodium intake was estimated using sex, age, race and hypertension status.
This study found that among adults ≥ 19 years old, about 89% consumed excess sodium. It was also found that a larger proportion of men (98%) than women (80%) consumed more than 2,300 mg of sodium per day (p<0.001). In addition, a larger proportion of white adults (90%) vs black adults (85%) consumed excess sodium (p=0.02). Among children 2-18 years old 92-94% consumed excess sodium over what was recommended for their age. 86% of adults with hypertension consumed an excess of 2,300 mg of sodium. This is significantly less than adults with prehypertension of whom 90% consumed excess sodium (p<0.001). In addition, the 86% of hypertension patients who consumed excess sodium is less than the 90% of adults without hypertension who consumed excess sodium (p=0.01). Interestingly, adults with hypertension had the lowest mean sodium intake when compared with prehypertension patients and patients without hypertension.
As expected, most adults and children in the United States exceed the 2015-2020 Dietary Guidelines for Americans recommendation for dietary sodium consumption. This is even true for patients who are at a higher risk for cardiovascular disease, thereby increasing their risk of stroke and coronary heart disease mortality. To address the high prevalence of excess sodium intake among the U.S. population, the Institute of Medicine (IOM) recommends reducing the sodium in our food supply. During the commercial processing of our food, excess sodium is added to the food for preservation and taste purposes. With this being said, commercial processed foods provide the main source of sodium intake in the American diet. There are a number of initiatives that aim to reduce the sodium content in foods to meet targets for specific food groups. For example, CDC’s Sodium Reduction in Communities Program and National Sodium Reduction Initiative have pledged to reduce sodium content in foods. Other programs, such as 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, operate to offer smarter choices to children and adults within the community. The fundamental public health strategy for reducing sodium consumption must start with food manufacturers and restaurants, as they are the main contributors to excess sodium in foods.
- This study found that among adults ≥ 19 years old, about 89% consumed excess sodium.
- To address the high prevalence of excess sodium intake among the U.S. population, the Institute of Medicine (IOM) recommends reducing the sodium in our food supply.
- Programs such as the CDC’s Sodium Reduction in Communities Program, National Sodium Reduction Initiative, 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 are working to decrease the amount of sodium added to our foods.
Researched and prepared by Jennifer Zahn, Doctor of Pharmacy Candidate University Of South Florida College of Pharmacy, reviewed by Dave Joffe, BSPharm, CDE
Jackson, Sandra L., et al. “Prevalence of Excess Sodium Intake in the United States—NHANES, 2009–2012.” MMWR. Morbidity and mortality weekly report 64.52 (2015): 1393-1397.