American children continue to consume sodium at high levels

ElsevierNov 4 2016

Cardiovascular disease, including heart disease and stroke, kills more than 800,000 Americans each year. We know that too much salt may contribute to high blood pressure and increased cardiovascular risk. According to a new study in the Journal of the Academy of Nutrition and Dietetics, American children are consuming sodium at levels that far exceed the daily recommended limit. Taste preferences for high sodium foods, formed as children, follow individuals into adulthood and put them at increased risk for developing cardiovascular problems later in life.

"Sodium reduction is considered a key public health strategy to reduce the risk of cardiovascular diseases nationwide and this study is the latest in ongoing CDC efforts to monitor U.S. sodium intake," explained lead author Zerleen S. Quader, MPH, a data analyst with the Centers for Disease Control and Prevention (CDC) Division for Heart Disease and Stroke Prevention. "We already know that nearly all Americans regardless of age, race, and gender consume more sodium than is recommended for a healthy diet and the excess intake is of great concern among particular youths."

Using data from the 2011-2012 National Health and Nutrition Examination Survey (NHANES), CDC researchers looked at the eating habits of 2,142 children between the ages of 6 and 18 years. They found that the average sodium intake for kids was 3,256 milligrams per day, not including any salt added at the table. The recommended intake for children varies from 1,900 mg/day to 2,300 mg/day depending on age. Nearly 90% of the children surveyed exceeded the upper level of sodium recommended for their age group and previous evidence suggests that one in nine children ages 8-17 years already has blood pressure above the normal range for their age, sex, and height, which increases their risk of high blood pressure as adults.

The study also found that high levels of sodium were being consumed throughout the day and from a variety of different sources. For example, they found 39% of sodium was consumed at dinner, 31% came from lunch, 16% from snacks, and 14% at breakfast. Researchers discovered that only 10 types of food made up almost 50% of kids' sodium intake. These included pizza, Mexican mixed dishes, sandwiches (including burgers), breads, cold cuts, soups, savory snacks, cheese, plain milk, and poultry.

Looking at where sodium-laden foods were purchased, researchers found that foods from the grocery store accounted for a substantial 58% of daily sodium intake, while fast-food/pizza contributed 16%, and the school cafeteria 10%. "With the exception of plain milk, which naturally contains sodium, the top ten food categories contributing to U.S. school children's sodium intake in 2011-2012 comprised foods in which sodium is added during processing or preparation," said Quader. "Sodium is consumed throughout the day from multiple foods and locations, highlighting the importance of sodium reduction across the U.S. food supply."

While sodium intake exceeded daily recommended levels across the board, the study found that average levels were even higher for teens ages 14-18 years (3,565 mg/day vs. 3,256 mg/day for all ages) and that girls had significantly lower daily intake than boys (2,919 mg/day for girls vs. 3,584 mg/day for boys); however, no significant differences in mean sodium intake were observed by race/ethnic group, household income, or child weight status.

This new study illustrates why identifying targets for sodium intervention can be tricky, since salt is ubiquitous in children's diets. It's also hard to pinpoint problem foods, since the sodium content of dishes can vary significantly according to how they are made and prepared. "It's surprising how much sodium content for the same food type can vary by product," described Quader. "The best way to reduce sodium intake from these products is to check the Nutrition Facts panel on packages and look for no-salt-added or lower-sodium versions."

The investigators have identified some important tips for parents and caregivers looking to help cut down sodium in kids' diets:

•Feed your children a diet rich in fresh fruits and vegetables without added sodium or sauces.
•Read nutrition labels. When shopping at the grocery store, look for the lowest sodium options for your child's favorite foods. An easy way to assess sodium in a food is to focus on the amount of sodium per serving. Those foods with less than 140 mg per serving are considered low in sodium.
•Request nutritional information at restaurants to find healthier options. Speak with your local grocer about stocking lower-sodium versions of foods.

While more attention is being paid to fostering good food habits early, salt could prove to be a challenging opponent. Researchers hope that this study can serve as a benchmark as more measures are put into place to reduce the amount of sodium kids consume. "The results support the need to reduce sodium content across the U.S. food supply rather than in a single type of food or venue," concluded Quader. "These data provide baseline information on sources of sodium intake among U.S. school-aged children that can be used to monitor changes in the food supply over time."