This presentation’s topic was “Sodium Reduction Monitoring and Applied Research”; the presenter Dr. Mary Cogswell covered background information on sodium then discussed sodium reduction and the types and accuracy of sodium intake measurement methods. Dr. Cogswell is a Senior Scientist with the Epidemiology and Surveillance Branch, Division for Heart Disease and Stroke Prevention at the Centers for Disease Control and also a Registered Nurse.
Dr. Cogswell’s introduction covered the differences between salt versus sodium, how the human body uses, processes and excretes sodium, its adverse affects, as well as additional facts on the topic. Sodium (Na) is an element found in nature, while table salt (NaCl) is a compound made of forty percent sodium and sixty percent chloride. Once ingested through the oral cavity and absorbed in the blood, the kidneys are the body’s main form of sodium regulation/filtration; almost 90% of consumed sodium is excreted through urine. In the body, sodium is essential to many functions, it is used to generate muscular contractions, maintain cell’s ion gradient, and regulate blood pressure. When your intake of sodium exceeds the body’s requirement, your kidneys can’t keep up and the body retains water to regulate levels; this excess fluid can increase blood pressure over time. The dietary reference intake (DRI) for sodium is just 2,300mg a day, however the average American’s intake is 3,400mg a day; Dr. Cogswell stated, “about 9/10 Americans exceed the DRI”. This excess consumption is evidence to the fact that forty-one percent of Cardio-Vascular Disease (CVD), the number one cause of death in the United States, can be attributed to high blood pressure. Dr. Cogswell explained that she addresses these facts initially because of a lack of public knowledge on sodium in general and the prevalence of problems that occur from its excess consumption. She went on to say, “current research shows that seventy-one percent of American’s daily sodium consumption comes from prepared or processed foods with restaurant food making up a large portion of this”. Taking this fact into consideration, sodium reduction seems simple; if Americans prepared more fresh food at home versus fast-food or carry-out we could greatly reduce or even eliminate excess sodium intake and/or high blood pressure. This is much easier said than done.
Different methods of sodium reduction monitoring was the next topic discussed in the presentation. Sodium intake can be measured with dietary recalls or biomarkers in the urine. In a dietary recall you record everything eaten and drank over the past 24-48 hours and add up the sodium content from each item to determine your daily intake. There are two different urine tests to determine sodium intake, a 24 hour urinary sodium excretion test and a one time (spot) urine assessment. The 24 hour method is accepted as the most accurate approach, in which an entire day’s worth of urine is collected and analyzed for total sodium content. In the spot assessment, one urine sample is collected and the volume is then multiplied by sodium content; this method is less accurate because it is a predicted amount and one sample’s sodium content can vary greatly.
One of the most interesting aspects of the presentation to me was the fact that 9/10 Americans are exceeding the DRI for sodium. I am a very health conscious person and it made me think to myself whether or not I might be over the DRI.. I actually brought up the conversation with my roommate and we discussed the foods we most commonly consume that might be sneaking extra sodium into our diets. With a quick Internet search we found that meat and dairy both contain a naturally high amount yet they pale in comparison to processed foods. I challenge those reading to also sit down and determine whether they are consuming over the DRI – your own consumption may surprise you!
As for how these facts are relevant to health intervention implementations, with CVD as the number one cause of death in the United States being attributed to high blood pressure, a condition frequently caused by high sodium intake, it seems that health practitioners could combat CVD by increasing public awareness of american’s high sodium intake. An intervention spreading tips for reducing sodium consumption in your diet could be implemented in neighborhoods and the effects studied. Before this presentation I had no idea that high sodium intake was such a prevalent issue; I can only assume that if I am lacking this knowledge so are many other Americans.
Matt – In regard to increasing public awareness on the risks of consuming high amounts of sodium, I want to draw your attention to the Million Hearts Initiative and the Sodium Reduction in Communities Program (SRCP). The CDC and Medicare and Medicaid Services both help lead Million Hearts with the main goal of preventing 1 million heart attacks and strokes by 2017. They have multiple aims to make this prevention possible, including helping to reduce Americans’ dietary sodium intake. The American Heart Association was awarded a five-year cooperative agreement to partner with Million Hearts in accomplishing their goal. They have various components in which they engage in to make this happen, most notably to “accelerate the spread and reach of evidence-based CVD prevention strategies to partners through the dissemination and promotion of key tools and resources.” On a condensed scale, SRCP “partners with local organizations that serve or sell food, such as schools, hospitals, and worksites, to implement sodium reduction strategies.” The CDC also currently funds eight communities to participate in this program with the goals of creating sustainable, community-level interventions, increasing food choice through access and availability, and monitoring and evaluating the results. Your awareness about struggles to reduce high sodium intake in the American diet may be limited because you have a healthy diet and lead an active lifestyle, so you most likely do not have to deal with this problem. Fortunately, for many Americans who share this daily struggle, there are resources available to them at the national and local level.
David,
I think that the Million Hearts Initiative is a good way to get started addressing CVD related deaths in general in the United States; although its goals are too broad to have a major impact on sodium reduction and awareness. The previous Million Hearts Initiative (MHI) took place from 2012-2016 and the priorities listed on their website included “Improving aspirin intake when appropriate, blood pressure control, cholesterol management, smoking cessation, promoting healthier levels of sodium consumption, improving physical activity levels, decreasing tobacco consumption, and improving outcomes for priority populations”. Although over the 5 years the MHI estimated 500,000 CVD deaths were prevented through their efforts, they also state “daily sodium intake hasn’t decline in the last 5 years“; I believe this can be attributed to the broad goals of the program. On the website MHI states “Widespread implementation of healthy food purchasing policies and voluntary industry adoption of recommendation for lower sodium food choices” was their major plan for reducing sodium. I believe the solution to actually reducing sodium intake on a national level requires a more focused approach to spread awareness of the risk of high sodium consumption but also informing the public on common high sodium foods, alternatives to those foods, and how to cook with reduced sodium alternatives. In my opinion the SRCP is a more ideal focused approach to addressing this national problem yet currently with just 8 communities involved it could hardly be listed as a resource to all americans on the local level. In the future with additional funding hopefully the SRCP is expanded and we may see an actual impact at the local level.
Hello Matt,
Thank you for presenting this information and statistics about sodium intake in the United States. It is a major public health concern along with type 2 diabetes and obesity, but it does not seem to get as much attention. Many foods that contain significant amounts of sodium are not what we consider “salty” foods, which makes awareness and education critical. You mention that a neighborhood/community intervention for sodium reduction would be an interesting research project. That would certainly be a good idea, but do you think that would be more effective than a national-level campaign or individual-level education? What would be your ideas for a community campaign? As you mention, many people are not aware of their sodium intake, so I wonder if individual self-monitoring would be a better way to raise awareness. On a national level, raising awareness could drive food companies and restaurants to make changes to their menus as well.
Emily,
In regards to the idea of an intervention, I suggested a community level implementation initially so that the effectiveness of a method could be tested without an excessive amount of time and money going to waste if it was found ineffective. I think that after a successful community-level implementation a national intervention would be the next step. I think that similar to the sugar sweetened beverage intervention we saw in class at the gas stations, sodium signs could be put up in local grocery stores showing the RDA of sodium to increase awareness of individual intake, then labeling common high sodium content product with amounts and tracking the amount of each product purchased verses a control measurement of the same products before the intervention. After viewing the outcomes of this it could be implemented nationally, maybe menus at restaurants could be labeled with sodium content similarly to how calories are currently.