Sodium and the Healthy Plate: AMA Perspective

Barry D. Dickinson, PhD

July 9, 2008

Leading Causes of Death-U.S.

• Heart disease (1)

• Cerebrovascular disease (3)

• Hypertensive renal disease (13)

• ~825,000 deaths attributable to cardiovascular diseases in 2005

Major Risk Factors for These Diseases

Hypertension

Hypercholesterolemia

Physical inactivity

Smoking

Obesity

Diabetes

Excessive alcohol consumption

Major Nutritional Risk Factors for These Diseases

High intake of: • Calories

• Saturated and trans fats

• Sodium

• Simple sugars

Low intake of:• Fruits and vegetables

• Whole grains

Recommendations for Daily Sodium Intake

• NHLBI (NHBPEP): <2400 mg daily

• AHA: < 2400 mg daily

• HHS Healthy People 2010: <2400 mg daily for 65% of the population

• WHO: <2000 mg daily

• NAS: Tolerable upper limit = 2300 mg Adequate Daily intake =1500 mg for those <50 years of age; 1300 mg for 51-70; and 1200 mg for those >71 years of age.

Dietary Guidelines for Americans

Consume less than 2,300 mg (approximately 1 tsp of salt) of sodium/day

Choose and prepare foods with little salt

Individuals with hypertension, blacks, and middle-aged and older adults: consume no more than 1,500 mg of sodium/day

Sodium Intake• Average adult sodium intake in U.S. is ~4000 mg

per 2000 calories

• ~77% comes from processed and restaurant foods; 12% occurs naturally; 11% added during cooking or at the table

• Many processed foods contain large amounts of sodium per serving; some foods and typical restaurant meals may approach or exceed recommended daily limits

• Intake goals cannot be achieved unless food processing and restaurant preparation practices in the U.S. are modified.

Hypertension – U.S.

• Defined as systolic blood pressure [SBP] ≥ 140 mm Hg and/or diastolic blood pressure [DBP] ≥ 90 mm Hg or taking antihypertensive medication

• ~28% of U.S. adults have hypertension

• More than 30% have prehypertension; CV risk increases as BP moves above 115/75 mm Hg

• Lifetime probability of developing HBP approaches 90%

• Blood pressure is affected by many variables and a reduced sodium intake is only 1 component.

Sodium and Cardiovascular Disease

• Range of current average Na+ intake is high relative to physiologic need.

• Correlations between Na+ intake and blood pressure or stroke established by observational studies, especially at the extremes of intake.

• Populations with average intakes <1300 mg daily have low blood pressure or no ↑ with age.

• Randomized clinical trials (and meta analysis) show that moderate Na+ reduction lowers BP in hypertensives and non-hypertensives, and lessens progression of prehypertension

• Largest “treatment” effects uncovered when trials of Na+ reduction lasting >4 weeks are included.

Other Effects of Excessive Sodium Intake• Independent predictor of left ventricular

mass

• Increases platelet reactivity

• Reduces arterial compliance

• Increases calcium excretion

• Increases caloric consumption by increasing fluid intake

AMA Policy on Sodium in Foods

H-150.990 Sodium in Processed Foods

..supports the efforts of food industries to achieve useful reductions in the sodium content of processed food, without compromising their safety or nutritive values.

AMA Policy on Menu Labeling

H-150.945 Nutrition Labeling and Nutritionally Improved Menu Offerings in Fast-Food and Other Chain Restaurants

The AMA recommends that nutrition information in fast-food and other chain restaurants include calorie, fat, saturated fat and trans fat, and sodium labeling on printed menus, and, at a minimum, calories on menu boards, since they have limited space, and that all nutrition information be conspicuous and easily legible.

AMA Policy on Foods and Sodium Intake

D-150.986 Promotion of Healthy Lifestyles I: Reducing the Population Burden of Cardiovascular Disease by Reducing Sodium Intake

Calls for a stepwise, minimum 50% reduction in sodium in processed foods, fast food products, and restaurant meals to be achieved over the next decade. Food manufacturers and restaurants should review their product lines and reduce sodium levels to the greatest extent possible (without increasing levels of other unhealthy ingredients). Gradual but steady reductions over several years may be the most effective way to minimize sodium levels.

AMA “Healthy Plate” Policies and Activities• Health Promotion• Addressing obesity—School, hospitals, worksites, and

food assistance programs to offer primarily healthy choices, such as fruits and vegetables; nutrition education and nutrition standards in schools

• Lowering sodium content of pre-packaged and restaurant foods

• Lower saturated fat content of fast food• Lower trans fats in all foods• Menu labeling• Nutritive quality of processed foods• Improving MyPyramid and Dietary Guidelines to

address different socioeconomic, ethnic and cultural groups

The Future of Food and Health

• Accessible, convenient, affordable, and good tasting fruits, vegetables and whole grains (including innovative packaging)

• Lower sodium, trans fats, and saturated fats in pre-packaged foods

• User-friendly food and menu labeling

• Informed consumers who seek out and purchase healthy options