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Sodium and the Healthy Plate: AMA Perspective
Sodium and the Healthy Plate: AMA Perspective
Sodium and the Healthy Plate: AMA Perspective
Sodium and the Healthy Plate: AMA Perspective
Sodium and the Healthy Plate: AMA Perspective
Sodium and the Healthy Plate: AMA Perspective
Sodium and the Healthy Plate: AMA Perspective
Sodium and the Healthy Plate: AMA Perspective
Sodium and the Healthy Plate: AMA Perspective
Sodium and the Healthy Plate: AMA Perspective
Sodium and the Healthy Plate: AMA Perspective
Sodium and the Healthy Plate: AMA Perspective
Sodium and the Healthy Plate: AMA Perspective
Sodium and the Healthy Plate: AMA Perspective
Sodium and the Healthy Plate: AMA Perspective
Sodium and the Healthy Plate: AMA Perspective
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Sodium and the Healthy Plate: AMA Perspective

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  • Among the many comments that could be made, let me correct a misstatement that has reached the order of “urban legend” in the nutrition policy community. You stated that the “Largest ‘treatment’ effects uncovered when trials of Na+ reduction lasting >4 weeks are included.” Actually, it’s just the reverse. As Julian Midgley et al explained in 1996 (http://www.ncbi.nlm.nih.gov/pubmed/8622251) excluding the shorter term trials REDUCED the intervention effect.

    The Trials of Hypertension Prevention, part 2, is the single best study to illustrate what happens. At baseline, the group systolic BP was 127.1 mmHg. After sustaining a 40 mmol (~ 960 mg) Na reduction for 36 months, the average SBP was 127.1 mmHg; it was statistically insignificant. At 6 months, the figures usually cited by salt proponents, the SBP had been reduced by a significant 5+ mmHg, but, while the salt reduction was maintained over three years, the BP effect dissolved. Blood pressure is an indicator, not an outcome. The body has redundant systems to keep BP where it wants it to be. If it’s high, that’s bad, but not because it’s caused by salt. Treating it with salt reduction is a poor strategy for two reasons: 1) salt reduction has a minimal impact, and 2) salt reduction activates the production of renin and aldosterone, stimulates the sympathetic nervous system and increases insulin resistance – all bad indicators. What we should be after is the best NET effect – hopefully an improvement in health.

    We hope AMA will reconsider its strong advocacy position and look more carefully at the evolving science which is all undermining AMA’s current position.



    Dick Hanneman

    Salt Institute
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  • 1. Sodium and the Healthy Plate: AMA Perspective Barry D. Dickinson, PhD July 9, 2008
  • 2. Leading Causes of Death-U.S. <ul><li>Heart disease (1) </li></ul><ul><li>Cerebrovascular disease (3) </li></ul><ul><li>Hypertensive renal disease (13) </li></ul><ul><li>~825,000 deaths attributable to cardiovascular diseases in 2005 </li></ul>
  • 3. Major Risk Factors for These Diseases <ul><li>Hypertension </li></ul><ul><li>Hypercholesterolemia </li></ul><ul><li>Physical inactivity </li></ul><ul><li>Smoking </li></ul><ul><li>Obesity </li></ul><ul><li>Diabetes </li></ul><ul><li>Excessive alcohol consumption </li></ul>
  • 4. Major Nutritional Risk Factors for These Diseases <ul><li>High intake of : </li></ul><ul><li>Calories </li></ul><ul><li>Saturated and trans fats </li></ul><ul><li>Sodium </li></ul><ul><li>Simple sugars </li></ul><ul><li>Low intake of : </li></ul><ul><li>Fruits and vegetables </li></ul><ul><li>Whole grains </li></ul>
  • 5. Recommendations for Daily Sodium Intake <ul><li>NHLBI (NHBPEP ): &lt;2400 mg daily </li></ul><ul><li>AHA : &lt; 2400 mg daily </li></ul><ul><li>HHS Healthy People 2010 : &lt;2400 mg daily for 65% of the population </li></ul><ul><li>WHO : &lt;2000 mg daily </li></ul><ul><li>NAS : Tolerable upper limit = 2300 mg Adequate Daily intake =1500 mg for those &lt;50 years of age; 1300 mg for 51-70; and 1200 mg for those &gt;71 years of age. </li></ul>
  • 6. Dietary Guidelines for Americans <ul><li>Consume less than 2,300 mg (approximately 1 tsp of salt) of sodium/day </li></ul><ul><li>Choose and prepare foods with little salt </li></ul><ul><li>Individuals with hypertension, blacks, and middle-aged and older adults: consume no more than 1,500 mg of sodium/day </li></ul>
  • 7. Sodium Intake <ul><li>Average adult sodium intake in U.S. is ~4000 mg per 2000 calories </li></ul><ul><li>~77% comes from processed and restaurant foods; 12% occurs naturally; 11% added during cooking or at the table </li></ul><ul><li>Many processed foods contain large amounts of sodium per serving; some foods and typical restaurant meals may approach or exceed recommended daily limits </li></ul><ul><li>Intake goals cannot be achieved unless food processing and restaurant preparation practices in the U.S. are modified. </li></ul>
  • 8. Hypertension – U.S. <ul><li>Defined as systolic blood pressure [SBP] ≥ 140 mm Hg and/or diastolic blood pressure [DBP] ≥ 90 mm Hg or taking antihypertensive medication </li></ul><ul><li>~28% of U.S. adults have hypertension </li></ul><ul><li>More than 30% have prehypertension; CV risk increases as BP moves above 115/75 mm Hg </li></ul><ul><li>Lifetime probability of developing HBP approaches 90% </li></ul><ul><li>Blood pressure is affected by many variables and a reduced sodium intake is only 1 component. </li></ul>
  • 9. Sodium and Cardiovascular Disease <ul><li>Range of current average Na + intake is high relative to physiologic need. </li></ul><ul><li>Correlations between Na + intake and blood pressure or stroke established by observational studies, especially at the extremes of intake. </li></ul><ul><li>Populations with average intakes &lt;1300 mg daily have low blood pressure or no ↑ with age. </li></ul><ul><li>Randomized clinical trials (and meta analysis) show that moderate Na + reduction lowers BP in hypertensives and non-hypertensives, and lessens progression of prehypertension </li></ul><ul><li>Largest “treatment” effects uncovered when trials of Na + reduction lasting &gt;4 weeks are included. </li></ul>
  • 10. Other Effects of Excessive Sodium Intake <ul><li>Independent predictor of left ventricular mass </li></ul><ul><li>Increases platelet reactivity </li></ul><ul><li>Reduces arterial compliance </li></ul><ul><li>Increases calcium excretion </li></ul><ul><li>Increases caloric consumption by increasing fluid intake </li></ul>
  • 11. AMA Policy on Sodium in Foods <ul><li>H-150.990 Sodium in Processed Foods </li></ul><ul><li>..supports the efforts of food industries to achieve useful reductions in the sodium content of processed food, without compromising their safety or nutritive values. </li></ul>
  • 12. AMA Policy on Menu Labeling <ul><li>H-150.945 Nutrition Labeling and Nutritionally Improved Menu Offerings in Fast-Food and Other Chain Restaurants </li></ul><ul><li>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. </li></ul>
  • 13. AMA Policy on Foods and Sodium Intake <ul><li>D-150.986 Promotion of Healthy Lifestyles I: Reducing the Population Burden of Cardiovascular Disease by Reducing Sodium Intake </li></ul><ul><li>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 . </li></ul>
  • 14. AMA “Healthy Plate” Policies and Activities <ul><li>Health Promotion </li></ul><ul><li>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 </li></ul><ul><li>Lowering sodium content of pre-packaged and restaurant foods </li></ul><ul><li>Lower saturated fat content of fast food </li></ul><ul><li>Lower trans fats in all foods </li></ul><ul><li>Menu labeling </li></ul><ul><li>Nutritive quality of processed foods </li></ul><ul><li>Improving MyPyramid and Dietary Guidelines to address different socioeconomic, ethnic and cultural groups </li></ul>
  • 15. The Future of Food and Health <ul><li>Accessible, convenient, affordable, and good tasting fruits, vegetables and whole grains (including innovative packaging) </li></ul><ul><li>Lower sodium, trans fats, and saturated fats in pre-packaged foods </li></ul><ul><li>User-friendly food and menu labeling </li></ul><ul><li>Informed consumers who seek out and purchase healthy options </li></ul>
  • 16. &nbsp;

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