Current CDC Efforts Concerning Sodium Intake

Transcription

1 Current CDC Efforts Concerning Sodium Intake Robert K. Merritt Chief & Supervisory Health Scientist Epidemiology & Surveillance Branch Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Institute of Medicine Washington, D.C. December 5, 2012 National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention

2 Disclaimer The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

3 Overview Population Sodium Intake CDC s Sodium Reduction Initiative Consequences of Sodium Reduction in Populations

4 POPULATION SODIUM INTAKE

5 Why Reduce Sodium Intake? Sodium intake is one of several factors that increases blood pressure In 2008, high blood pressure was reported as a primary or contributing cause of ~348,000 US deaths About one-in-three U.S. adults have high blood pressure and fewer than half have their blood pressure under control

6 Percent of population Prevalence of Hypertension Among Adults Aged 20 Years by Age and Sex: NHANES Men Women Weighted, unstandardized estimates. Pregnant women excluded.

7 Burden of Excess Sodium Intake Sodium, through hypertension, is a major contributor to death, disability, and health disparities attributable to cardiovascular diseases (CVDs) Leading causes of death (~800,000 adults/year) Leading causes of health disparities Treatment for heart disease, stroke, and other CVD accounts for 1 in 6 U.S. health dollars spent ($273 billion in 2008) Vital Signs: MMWR 2011; 60(4):1-3 8; Heidenreich PA, et al. Circulation 2011;123; ; Asaria P, et al. Lancet 2007;370:

8 Sodium Intake Levels: Recommended and Actual Recommended levels of sodium intake 2010 Dietary Guidelines for Americans Reduce sodium to < 2300 mg/day For specific populations: 1,500 mg/day 51 years old African Americans Have high blood pressure, diabetes, or chronic kidney disease About half the U.S. population and the majority of adults Actual sodium intake Average daily sodium intake for U.S. adults is >3,300 mg/day USDA and HHS. Dietary Guidelines for Americans, th edition. Washington, DC: Government Printing Office; 2010 CDC. MMWR 2011;60:

9 Percent of US persons exceeding their 2010 Dietary Guidelines for Americans sodium intake recommendations % <2,300 mg/d 1,500 mg/d 2+ yrs 2-17 yrs yrs 51+ yrs* Age Group *All people age 51 and older should reduce sodium intake to 1,500 mg/day. MMWR 2011;60:

10 Other Guidelines and Recommendations Million Hearts Reduce population sodium intake by 20% by January 1, 2017 Healthy People 2020 Reduce mean U.S. population sodium intake to 2,300 mg per day by 2020 Institute of Medicine Reduce the sodium content of the U.S. food supply American Heart Association Reduce population sodium intake to 1500 mg per day American Medical Association Stepwise, minimum 50% reduction in sodium in processed foods, fast-food products, and restaurant meals over the next decade

11 Most of the Sodium We Eat Comes from Processed and Restaurant Foods 12% 6% 5% Processed and restaurant foods Naturally occurring While eating 77% Home cooking Mattes RD, et al. J AM Coll Nutr 1991;10:

12 CDC, MMWR;2012;61: % of U.S. Sodium Intake Comes from Ten Types of Foods Rank Food Types % 1 Bread and rolls Cold cuts and cured meats Pizza Poultry Soups Sandwiches Cheese Pasta mixed dishes Meat mixed dishes Savory snacks 3.1

13 IOM Strategies to Reduce Sodium Intake excess sodium intake is strongly associated with elevated blood pressure, a serious public health concern related to increased risk of heart disease, stroke, congestive heart failure, and renal disease. The current level of sodium added to the food supply by food manufacturers, foodservice operators, and restaurants is simply too high to be safe for consumers.

14 IOM Recommendations Primary Strategy FDA should expeditiously initiate a process to set mandatory national standards for the sodium content of foods Applies to processed and restaurant foods Utilize Generally Recognized As Safe (GRAS) status of salt Interim Strategy Food industry should voluntarily act to reduce the sodium content of foods in advance of the implementation of mandatory standards Supporting Strategies Nutrition labeling, procurement, consumer education

15 IOM Supporting Strategies - Surveillance Critical need to ensure the continuation of monitoring and surveillance relevant to sodium intake as well as to initiate efforts to immediately establish baseline data Federal agencies should ensure and enhance monitoring and surveillance relative to sodium intake measurement, salt taste preference, and sodium content of foods Urine collection Knowledge, Attitudes, Behaviors

16 CDC S SODIUM REDUCTION INITIATIVE

17 Monitoring and Surveillance Sodium in Foods Sodium Intake Knowledge, Attitudes, and Behaviors Health Care Costs and Health Outcomes

18 Sodium in Foods Packaged food database Restaurant data

19 Sodium Intake Dietary NHANES usual sodium intake Sources of sodium (contracted study) Biomarker INTERSALT project Calibration study 24-hour urine pilot Historic spot samples

20 Assessing Sodium Intake with Spot Urines Advantages High participation Low burden Disadvantages Diurnal variation in sodium excretion Large (+50% of mean) Reversed in people with hypertension Magnitude varies by race Most commonly used prediction equations developed in Asian populations - bias in western populations unclear Assessing long term individual sodium intake requires more observation days with spot than 24-h urine collections Dyer et al., Hypertension, 1987; Bankir et al., Am Soc Nephrol 2007; Liu et al., Hypertension, 1979; Pietinen, Prev Med 1976; Lisheng et al., J Hypertension, 1979.

21 Knowledge, Attitudes, and Behaviors Consumer awareness can drive action aimed at sodium reduction CDC continues to Develop additional survey questions and analyze existing data to better determine consumer knowledge, attitudes, and behaviors related to sodium reduction Develop and disseminate consumer oriented materials related to sodium reduction Resources may be found at

22 Health Care Costs and Health Outcomes Literature review of cost-effectiveness of interventions designed to reduce sodium intake Estimates of sodium consumption on mortality from modeling studies Association of usual sodium intake and mortality using NHANES data Findings suggest higher sodium intake is associated with increased total mortality in the general U.S. population Higher sodium-potassium ratio is associated with significantly increased risk of CVD and all-cause mortality Data Trends and Maps

23 CDC-Funded Sodium Reduction in Communities Program (SRCP) Five grantees (6 communities) funded in 2010 $1.9 million annually over 3-year funding period Reduce sodium intake across the population through systems and environmental change strategies Build upon existing community strategies and coalitions Evaluation and media components

24 CONSEQUENCES OF SODIUM REDUCTION IN POPULATIONS

25 Convening the Study Virtually all Americans exceed recommended levels for sodium intake The causal link between sodium intake and high blood pressure is well-established Reducing population sodium intake may save thousands of lives and billions of health-care dollars annually Despite this evidence, some studies raise questions on possible negative health consequences of reducing sodium AHA recently analyzed studies reporting the impact of sodium reduction on CVD and stroke risk concluded available data indicate strong support for reducing sodium intake to <1,500 mg per day

26 Resources Available at

27 CDC Staff Molly Cogswell Janelle Gunn Jessica Levings DHANES/NCHS Acknowledgements Federal Collaborators FDA NHLBI/NIH USDA

28 For More Information Centers for Disease Control and Prevention Robert K. Merritt For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention