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Sodium and the Dietary Guidelines
 

Sodium and the Dietary Guidelines

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    Sodium and the Dietary Guidelines Sodium and the Dietary Guidelines Presentation Transcript

    • Sodium and The Dietary Guidelines Nutrient Essentials Penny Kris-Etherton, Ph.D., R.D. Department of Nutritional Sciences Pennsylvania State University
    • Outline
        • Dietary Guidelines for Americans, 2005
          • General Recommendations
          • Recommendations for Sodium and Potassium
        • AHA Diet and Lifestyle Revision, 2006
          • General Recommendations
          • Recommendations for Sodium and Potassium
        • Strategies to Achieve Sodium Recommendations
          • Sources of Sodium in the Diet
          • AHA Recommendations for Restaurants and the Food Industry
        • Long Range Goal –Achieve Dietary Pattern Consistent with Current Dietary Recommendations
          • Minnesota Heart Survey
        • Summary
    • Dietary Guidelines for Americans, 2005 Key Scientific Recommendations
      • Consume a variety of foods within and among the basic food groups while staying within energy needs
      • Control calorie intake to manage body weight
      • Be physically active every day
      • Increase daily intake of fruits and vegetables, whole grains, and reduced-fat milk and milk products
      • Choose fats wisely for good health
      • Choose carbohydrates wisely for good health
      • Choose and prepare foods with little salt
      • If you drink alcoholic beverages, do so in moderation
      • Keep food safe to eat
    • Sodium and Potassium
      • Consume < 2,300 mg (~1 tsp. salt) of sodium per day
      • Choose and prepare foods with little salt. At the same time, consume potassium-rich foods, such as fruits and vegetables.
    • Dietary Guidelines, 2005 Recommendations for Special Populations
      • Specific recommendations for individuals with hypertension, blacks, and middle-aged and older adults
        • Aim to consume no more than 1,500 mg of sodium per day, and meet the potassium recommendation (4,700 mg) with food.
    • AHA Diet and Lifestyle Goals for Cardiovascular Disease Risk Reduction
      • Consume an overall healthy diet
      • Aim for healthy body weight
      • Aim for recommended levels of LDL-C, HDL-C and triglycerides
      • Aim for normal blood pressure
      • Aim for normal blood glucose level
      • Be physically active
      • Avoid use of and exposure to tobacco products
      Lichtenstein et al., Circulation, 114, 82-96, 2006
    • AHA Diet and Lifestyle Recommendations for Cardiovascular Disease Risk Reduction
      • Balance calorie intake and activity to achieve a healthy weight
      • Consume diet rich in fruits & vegetables
      • Choose whole-grain, high-fiber foods
      • Consume fish, especially oily fish, 2X per week
      • Limit intake of saturated fat to <7% of calories, trans fat to <1% of calories and cholesterol to < 300 mg per day by:
        • Choosing lean meats and vegetable alternatives
        • Selecting fat-free, 1% or low-fat dairy products
        • Minimizing intake of partially hydrogenated fats
      • Minimize intake of added sugars
      • Choose and prepare foods with little or no added salt
      • If you consume alcohol, do so in moderation
      • When you eat food outside the home, follow the AHA Recommendations
      Lichtenstein et al., Circulation, 114, 82-96, 2006
    • Current Dietary Recommendations for Sodium & Potassium 2003-2006 Consume less than 2.4 g/d 2003 NIH/ NHLBI, JNC 7 AI = 1.5 g/d, UL = 2.3 g/d Potassium, AI = 4.7 g/d 2004 DRI from National Academies Consume less than 2.3 g/d; persons with hypertension, blacks, middle-age & older adults: 1.5 g/d. Increase potassium to 4.7 g/d 2005 Dietary Guidelines for Americans Lower salt intake as much as possible: 1.5 g/d Increase potassium to 4.7 g/d 2006 AHA Science Statement on Prevention and Treatment of Hypertension An achievable goal – 2.3 g/d; upper level could be as low as 1.5 g/d 2006 AHA Diet and Lifestyle Revision
    • Less Than 25% of Population has Sodium Intake of 2400 mg or Less National Health and Nutrition Examination Survey, NCHS, CDC
    • Less Than 5 % of U.S. Population Meets Adequate Intake (from DRI’s) for Potassium *AI from DRIs ** statistically unreliable National Health and Nutrition Examination Survey, NCHS, CDC
    • Lifestyle Modifications to Manage Hypertension Source: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7. Report. JAMA. 2003;289:2560-2572. 2-4 mm Hg Limit alcohol to no more than 2 drinks/d for men and 1 drinks/day for women. Moderate alcohol consumption 4-9 mm Hg Engage in regular aerobic activity such as walking (30 min/day on most days) Increase physical activity 2-8 mm Hg Reduce sodium to no more than 2.4 g/day sodium or 6 g/day NaCl Dietary sodium reduction 8-14 mm Hg Consume diets rich in fruits, vegetables, low fat dairy and low saturated fat Adapt DASH eating plan 5-20 mm Hg for each 10 kg weight loss Maintain normal body weight (BMI 18.5-24.9) Weight Reduction Approximate SBP Reduction Recommendations Modification
    • USDA Food Guide - Food Group Recommendations 132 22 g 3 c 5 oz. equivalent 5 oz. equivalent 3 oz. 2 oz. 2 c (4 serv) 2 c/wk 1.5 c/wk 2.5 c/wk 2.5 c/wk 5.5 c/wk 1.5 c (3 serv) 1600 kcals 31 g 24 g Oils 362 267 Discretionary kcal Milk Lean meat/beans Grains whole grains other grains Vegetables dark green orange legumes starchy other Fruits 3 c 3 c 6.5 oz. equivalent 5.5 oz. equivalent 8 oz. equivalent 4 oz. 4 oz. 6 oz. equivalent 3 oz. 3 oz. 3 c (6 serv) 3 c/wk 2 c/wk 3 c/wk 6 c/wk 7 c/wk 2.5 c (5 serv) 3 c/wk 2 c/wk 3 c/wk 3 c/wk 6.5 c/wk 2 c (4 serv) 2 c (4 serv) 2400 kcals 2000 kcals
    •  
      • What is a &quot;Healthy Diet&quot;? The Dietary Guidelines describe a healthy diet as one that
      • Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products;
      • Includes lean meats, poultry, fish, beans, eggs, and nuts; and
      • Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars .
      • Why is it important to eat fruits and vegetables?
      • Eating fruit and vegetables provides health benefits – people who eat more fruits and vegetables as part of an overall healthy diet are likely to have a reduced risk of some chronic diseases.
      • Most fruits are naturally low in fat, sodium and calories.
      • Fruits and vegetables are important sources of potassium , dietary fiber, vitamin C & A and folate
      • Prepare foods from fresh ingredients to lower sodium intake. If buying canned vegetables, select those labeled “no salt added”
      www.MyPyramid.gov
    • Macronutrient Profile of a Mypyramid.gov Recommended 2000 kcal diet N/A Alcohol 1779 Sodium, mg/day 31 Fiber, gm/day 230 Cholesterol, mg/day N/A Trans FA 8.9 PUFA, % energy 10.7 MUFA, % energy 7.8 SFA, % energy 29 Total Fat, % energy 18 Protein, % energy 55 Carbohydrate, % energy 1987 Energy , kcal/day
    • DASH PYRAMID
    • cartoonstock.com
    • Sources of Sodium in the Diet Food Processing 77% Inherent in foods 12% Added at table 6% Added during cooking 5%
    • Food Group Contributions to Sodium Intake as a % of Total Intake Grain Products 37% Meat, Poultry, Fish, Beans, Eggs, Nuts 35% Vegetables 14% Milk Products 8% Fats & oils 4% Beverages, Sugars, Sweets 2% Fruits <1% CNPP Nutrition Insights 1997
    • Yes, Mr. Smith. You don’t salt anything, but you do eat a lot of sodium! But, Doctor, I Never Use A Salt Shaker
    • Low-Sodium Cookbooks
    •  
    • High-priority Recommendations to Facilitate Adoption of AHA Diet and Lifestyle Recommendations
      • Groups included: Health Practitioners, Restaurants, Food Industry, Schools, Local Government
      • Specific Recommendations
        • Restaurants
          • Display calorie content or make information easily accessible
          • Reduce portion sizes
          • Reformulate products to reduce calories, sodium, saturated and trans fat
          • Provide more vegetable options, and prepare them with minimal added calories and salt
          • Provide more fruit options, with minimal added sugar
          • Develop creative marketing approaches for fruits & vegetables
          • Allow healthy substitutions
          • Provide whole-grain options
      Adapted from Lichtenstein et al., Circulation, 114, 82-96, 2006
    • High-priority Recommendations to Facilitate Adoption of AHA Diet and Lifestyle Recommendations
      • Groups included: Health Practitioners, Restaurants, Food Industry, Schools, Local Government
      • Specific Recommendations
        • Food Industry
          • Reduce salt and sugar content of processed foods
          • Replace saturated and trans fat in prepared foods with low-saturated fat oils
          • Increase proportion of whole grain foods available
          • Package foods in smaller portion sizes
          • Develop packaging that allows more stability, preservation and palatability of fresh fruits & vegetables without added sodium
      Adapted from Lichtenstein et al., Circulation, 114, 82-96, 2006
    • Practical Tips to Implement AHA Diet and Lifestyle Recommendations (Sodium Related)
      • Food choices and preparation
        • Use nutrition facts panel and ingredients list to choose food purchases
      • Eat fresh, frozen and canned vegetables and fruits without high-calorie sauces, added salt and sugars
      • Reduce salt intake by:
        • Comparing sodium content of products and choosing ones with less salt
        • Choosing reduced sodium versions or foods, including cereals and baked goods
        • Limiting condiments (eg. soy sauce, ketchup)
      • Limit processed meat intake, especially those high in saturated fat and sodium
      Lichtenstein et al., Circulation, 114, 82-96, 2006
    • Lee S. et al., JADA, 107:213-222, 2007 Minnesota Heart Survey : Overall HDPEI Scores Between 1980 and 2002; improvements level off from 1995-2002
    • Improvements in Selected Variables Across Quintiles of the Heart Disease Prevention Eating Index (HDPEI) –Minnesota Heart Survey (n=11,439) mean score Lee S. et al., JADA, 107:213-222, 2007 <0.01 3088 3423 3427 3304 3437 Sodium, mg/d <0.01 167 226 266 295 378 Cholesterol, mg/d <0.01 1.8 2.3 2.6 2.7 3.0 % en from TFA <0.01 8.3 11.1 12.4 13.6 15.3 % en from SFA <0.01 27.0 32.6 35.0 37.2 40.9 % en from Total Fat <0.01 24.8 25.8 26.7 27.8 30.1 BMI P for trend Q5 44.0 Q4 36.9 Q3 32.8 Q2 28.7 Q1 22.3 Variable (means)
    • Summary
      • Current dietary guidance targets sodium reduction, and provides strategies for implementation
      • Given the widespread distribution of sodium in the food supply, there are many targets
      • The restaurant and food industry can play a key role in decreasing sodium and helping consumers adhere to dietary recommendations