Usual Sodium Intakes Compared With Current Dietary Guidelines

United States, 2005-2008

Catherine M. Loria, PhD; Michael E. Mussolino, PhD; Mary E. Cogswell, DrPH; Cathleen Gillespie, MS; Janelle P. Gunn, MPH; Darwin R. Labarthe, MD, PhD; Sharon Saydah, PhD, Meda E. Pavkov, MD

Disclosures

Morbidity and Mortality Weekly Report. 2011;60(41):1413-1417. 

In This Article

Abstract and Introduction

Introduction

High sodium intake can increase blood pressure and the risk for heart disease and stroke.[1,2] According to the Dietary Guidelines for Americans, 2010,[3] persons in the United States aged ≥2 years should limit daily sodium intake to <2,300 mg. Subpopulations that would benefit from further reducing sodium intake to 1,500 mg daily include 1) persons aged ≥51 years, 2) blacks, and 3) persons with hypertension, diabetes, or chronic kidney disease.[3] To estimate the proportion of the U.S. population for whom the 1,500 mg recommendation applies and to assess the usual sodium intake for those persons, CDC and the National Institutes of Health used data for 2005–2008 from the National Health and Nutrition Examination Survey (NHANES). This report summarizes the results of that assessment, which determined that, although 47.6% of persons aged ≥2 years meet the criteria to limit their daily sodium intake to 1,500 mg, the usual daily sodium intake for 98.6% of those persons was >1,500 mg. Moreover, for 88.2% of the remaining U.S. population, daily sodium intake was greater than the recommended <2,300 mg. New population-based strategies and increased public health and private efforts will be needed to meet the Dietary Guidelines recommendations.

NHANES is a nationally representative, multistage survey of the U.S. non-institutionalized population.* During NHANES 2005–2008, a total of 18,823 participants aged ≥2 years were interviewed and examined. Blood pressure was measured, blood and urine were collected for testing, and a 24-hour dietary recall was administered. A second 24-hour dietary recall was administered by telephone 3–10 days later. Dietary intake for children aged 2–5 years was recalled by a proxy, for children 6–11 years by the participant assisted by a proxy, and for all others by the participant. Examination response rates were 76% during the study period. Excluded from the initial sample were pregnant women, women whose pregnancy status was not recorded (694), and participants who reported being on renal dialysis (39). Among participants aged ≥12 years, 5,508 were randomly assigned to a morning examination, fasted for 8–24 hours, and had fasting plasma glucose, glycohemoglobin (HbA1c), serum creatinine concentration, and urine albumin and creatinine measured. Excluded were persons with missing diabetes data (18) or blood pressure data (898), yielding an analytic sample of 9,468 participants, 4,268 aged 2–11 years and 5,200 aged ≥12 years.

Persons with a recommended daily sodium intake of 1,500 mg had at least one of the following characteristics: age ≥51 years, non-Hispanic black race, or hypertension, diabetes, or chronic kidney disease. Hypertension was defined as mean systolic blood pressure ≥140 mm Hg, mean diastolic blood pressure ≥90 mm Hg, or self-reported use of antihypertensive medication; diabetes as self-reported diagnosis by a health-care provider, HbA1c ≥6.5%, or fasting plasma glucose ≥126 mg/dL; and chronic kidney disease as an estimated glomerular filtration rate <60 mL/min/1.73 m2 or urinary albumin-creatinine ratio >30 mg/g.[4,5]

Mean usual sodium intakes and proportions of the subpopulation with intake above 1,500 mg/day and at or above 2,300/mg day were estimated from up to two 24-hour dietary recalls using statistical software to account for day-to-day variation in intake with jackknife replicate weights based on survey sample weights to estimate standard errors and confidence intervals. For all other analyses, statistical software for complex surveys was used with the survey sample weights. For participants aged ≥12 years, survey sample weights for the fasting subsample were used. For participants aged 2–11 years, survey sample weights for the medical examination and first day diet sample were used.

Among the U.S. population aged ≥2 years in 2005–2008, an estimated 47.6% of the population met the criteria to limit sodium intake to 1,500 mg daily, according to the 2010 Dietary Guidelines (Table 1). Although this proportion differed by sex, that difference was not statistically significant after adjusting for age and race/ethnicity. The proportion of the population with a 1,500 mg daily recommendation was higher among adults (57.1%) than among children (16.2%). Among non-Hispanic blacks, non-Hispanic whites, and Mexican Americans aged ≥2 years, 100.0%, 44.1%, and 23.7%, respectively, were advised to limit their sodium intake to 1,500 mg daily.

Among persons aged ≥2 years with a 1,500 mg daily recommendation, 98.6% consumed >1,500 mg sodium on a usual daily basis, including 99.4% of those aged ≥18 years (Table 2). Among those with a sodium recommendation of <2,300 mg daily, 88.2% consumed ≥2,300 mg on a usual daily basis, including 95.0% of those aged ≥18 years.

* Additional information available at http://www.cdc.gov/nchs/nhanes.htm.
Based on the estimated number of persons who were firefighters (305,500), competitive athletes (13,620), and foundry mold and coremakers (13,550) as of May 2009 (data available at http://www.bls.gov/oes/current/oes_alph.htm), divided by the estimated U.S Census Population as of July 1, 2009 (307,006,550).
§ Additional information available at http://www.cdc.gov/dhdsp/programs/sodium_reduction.htm.
Additional information available at http://www.cdc.gov/salt/pdfs/dhdsp_procurement_guide.pdf.
** Additional information available at http://www.gsa.gov/portal/content/104429.
†† Additional information available at http://www.fns.usda.gov/fdd/news/schupdates1010.pdf.
§§ Additional information available at http://www.fda.gov/food/newsevents/constituentupdates/ucm271915.htm.
¶¶ Additional information available at http://www.food.gov.uk/multimedia/pdfs/08sodiumreport.pdf.
*** Additional information available at http://www.food.gov.uk/multimedia/pdfs/consultation/iarevsaltredtargets.pdf.
††† Additional information available at http://www.nyc.gov/html/doh/html/cardio/cardio-salt-initiative.shtml.

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