Sodium and The Dietary Guidelines Nutrient Essentials Penny Kris-Etherton, Ph.D., R.D. Department of Nutritional Sciences ...
Outline <ul><ul><li>Dietary Guidelines for Americans, 2005 </li></ul></ul><ul><ul><ul><li>General Recommendations </li></u...
Dietary Guidelines for Americans, 2005   Key Scientific Recommendations <ul><li>Consume a variety of foods within and amon...
Sodium and Potassium <ul><li>Consume < 2,300 mg (~1 tsp. salt) of sodium per day </li></ul><ul><li>Choose and prepare food...
Dietary Guidelines, 2005 Recommendations for Special Populations <ul><li>Specific recommendations for individuals with hyp...
AHA Diet and Lifestyle Goals for Cardiovascular Disease Risk Reduction <ul><li>Consume an overall healthy diet </li></ul><...
AHA Diet and Lifestyle Recommendations for Cardiovascular Disease Risk Reduction <ul><li>Balance calorie intake and activi...
Current Dietary Recommendations for Sodium &  Potassium  2003-2006 Consume less than 2.4 g/d 2003 NIH/ NHLBI, JNC 7 AI = 1...
Less Than 25% of Population has  Sodium Intake of 2400 mg or Less National Health and Nutrition Examination Survey, NCHS, ...
Less Than 5 % of U.S. Population  Meets Adequate Intake (from DRI’s) for Potassium *AI from DRIs ** statistically unreliab...
Lifestyle Modifications to Manage Hypertension Source: The Seventh Report of the Joint National Committee on Prevention, D...
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/w...
 
<ul><li>What is a &quot;Healthy Diet&quot;? The Dietary Guidelines describe a  healthy diet  as one that  </li></ul><ul><l...
<ul><li>Why is it important to eat fruits and vegetables? </li></ul><ul><li>Eating fruit and vegetables provides health be...
Macronutrient Profile of a Mypyramid.gov Recommended 2000 kcal diet N/A Alcohol 1779 Sodium, mg/day 31 Fiber, gm/day 230 C...
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...
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 <ul><li>Groups included: He...
High-priority Recommendations to Facilitate Adoption of AHA Diet and Lifestyle Recommendations <ul><li>Groups included: He...
Practical Tips to Implement AHA Diet and Lifestyle Recommendations (Sodium Related) <ul><li>Food choices and preparation <...
Lee S. et al., JADA, 107:213-222, 2007 Minnesota Heart Survey :  Overall HDPEI Scores Between 1980 and 2002;  improvements...
Improvements in Selected Variables Across Quintiles of the Heart Disease Prevention Eating Index (HDPEI) –Minnesota Heart ...
Summary <ul><li>Current dietary guidance targets sodium reduction, and provides strategies for implementation </li></ul><u...
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Sodium and the Dietary Guidelines

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Sodium and the Dietary Guidelines

  1. 1. Sodium and The Dietary Guidelines Nutrient Essentials Penny Kris-Etherton, Ph.D., R.D. Department of Nutritional Sciences Pennsylvania State University
  2. 2. Outline <ul><ul><li>Dietary Guidelines for Americans, 2005 </li></ul></ul><ul><ul><ul><li>General Recommendations </li></ul></ul></ul><ul><ul><ul><li>Recommendations for Sodium and Potassium </li></ul></ul></ul><ul><ul><li>AHA Diet and Lifestyle Revision, 2006 </li></ul></ul><ul><ul><ul><li>General Recommendations </li></ul></ul></ul><ul><ul><ul><li>Recommendations for Sodium and Potassium </li></ul></ul></ul><ul><ul><li>Strategies to Achieve Sodium Recommendations </li></ul></ul><ul><ul><ul><li>Sources of Sodium in the Diet </li></ul></ul></ul><ul><ul><ul><li>AHA Recommendations for Restaurants and the Food Industry </li></ul></ul></ul><ul><ul><li>Long Range Goal –Achieve Dietary Pattern Consistent with Current Dietary Recommendations </li></ul></ul><ul><ul><ul><li>Minnesota Heart Survey </li></ul></ul></ul><ul><ul><li>Summary </li></ul></ul>
  3. 3. Dietary Guidelines for Americans, 2005 Key Scientific Recommendations <ul><li>Consume a variety of foods within and among the basic food groups while staying within energy needs </li></ul><ul><li>Control calorie intake to manage body weight </li></ul><ul><li>Be physically active every day </li></ul><ul><li>Increase daily intake of fruits and vegetables, whole grains, and reduced-fat milk and milk products </li></ul><ul><li>Choose fats wisely for good health </li></ul><ul><li>Choose carbohydrates wisely for good health </li></ul><ul><li>Choose and prepare foods with little salt </li></ul><ul><li>If you drink alcoholic beverages, do so in moderation </li></ul><ul><li>Keep food safe to eat </li></ul>
  4. 4. Sodium and Potassium <ul><li>Consume < 2,300 mg (~1 tsp. salt) of sodium per day </li></ul><ul><li>Choose and prepare foods with little salt. At the same time, consume potassium-rich foods, such as fruits and vegetables. </li></ul>
  5. 5. Dietary Guidelines, 2005 Recommendations for Special Populations <ul><li>Specific recommendations for individuals with hypertension, blacks, and middle-aged and older adults </li></ul><ul><ul><li>Aim to consume no more than 1,500 mg of sodium per day, and meet the potassium recommendation (4,700 mg) with food. </li></ul></ul>
  6. 6. AHA Diet and Lifestyle Goals for Cardiovascular Disease Risk Reduction <ul><li>Consume an overall healthy diet </li></ul><ul><li>Aim for healthy body weight </li></ul><ul><li>Aim for recommended levels of LDL-C, HDL-C and triglycerides </li></ul><ul><li>Aim for normal blood pressure </li></ul><ul><li>Aim for normal blood glucose level </li></ul><ul><li>Be physically active </li></ul><ul><li>Avoid use of and exposure to tobacco products </li></ul>Lichtenstein et al., Circulation, 114, 82-96, 2006
  7. 7. AHA Diet and Lifestyle Recommendations for Cardiovascular Disease Risk Reduction <ul><li>Balance calorie intake and activity to achieve a healthy weight </li></ul><ul><li>Consume diet rich in fruits & vegetables </li></ul><ul><li>Choose whole-grain, high-fiber foods </li></ul><ul><li>Consume fish, especially oily fish, 2X per week </li></ul><ul><li>Limit intake of saturated fat to <7% of calories, trans fat to <1% of calories and cholesterol to < 300 mg per day by: </li></ul><ul><ul><li>Choosing lean meats and vegetable alternatives </li></ul></ul><ul><ul><li>Selecting fat-free, 1% or low-fat dairy products </li></ul></ul><ul><ul><li>Minimizing intake of partially hydrogenated fats </li></ul></ul><ul><li>Minimize intake of added sugars </li></ul><ul><li>Choose and prepare foods with little or no added salt </li></ul><ul><li>If you consume alcohol, do so in moderation </li></ul><ul><li>When you eat food outside the home, follow the AHA Recommendations </li></ul>Lichtenstein et al., Circulation, 114, 82-96, 2006
  8. 8. 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
  9. 9. Less Than 25% of Population has Sodium Intake of 2400 mg or Less National Health and Nutrition Examination Survey, NCHS, CDC
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 14. <ul><li>What is a &quot;Healthy Diet&quot;? The Dietary Guidelines describe a healthy diet as one that </li></ul><ul><li>Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products; </li></ul><ul><li>Includes lean meats, poultry, fish, beans, eggs, and nuts; and </li></ul><ul><li>Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars . </li></ul>
  14. 15. <ul><li>Why is it important to eat fruits and vegetables? </li></ul><ul><li>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. </li></ul><ul><li>Most fruits are naturally low in fat, sodium and calories. </li></ul><ul><li>Fruits and vegetables are important sources of potassium , dietary fiber, vitamin C & A and folate </li></ul><ul><li>Prepare foods from fresh ingredients to lower sodium intake. If buying canned vegetables, select those labeled “no salt added” </li></ul>www.MyPyramid.gov
  15. 16. 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
  16. 17. DASH PYRAMID
  17. 18. cartoonstock.com
  18. 19. Sources of Sodium in the Diet Food Processing 77% Inherent in foods 12% Added at table 6% Added during cooking 5%
  19. 20. 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
  20. 21. Yes, Mr. Smith. You don’t salt anything, but you do eat a lot of sodium! But, Doctor, I Never Use A Salt Shaker
  21. 22. Low-Sodium Cookbooks
  22. 24. High-priority Recommendations to Facilitate Adoption of AHA Diet and Lifestyle Recommendations <ul><li>Groups included: Health Practitioners, Restaurants, Food Industry, Schools, Local Government </li></ul><ul><li>Specific Recommendations </li></ul><ul><ul><li>Restaurants </li></ul></ul><ul><ul><ul><li>Display calorie content or make information easily accessible </li></ul></ul></ul><ul><ul><ul><li>Reduce portion sizes </li></ul></ul></ul><ul><ul><ul><li>Reformulate products to reduce calories, sodium, saturated and trans fat </li></ul></ul></ul><ul><ul><ul><li>Provide more vegetable options, and prepare them with minimal added calories and salt </li></ul></ul></ul><ul><ul><ul><li>Provide more fruit options, with minimal added sugar </li></ul></ul></ul><ul><ul><ul><li>Develop creative marketing approaches for fruits & vegetables </li></ul></ul></ul><ul><ul><ul><li>Allow healthy substitutions </li></ul></ul></ul><ul><ul><ul><li>Provide whole-grain options </li></ul></ul></ul>Adapted from Lichtenstein et al., Circulation, 114, 82-96, 2006
  23. 25. High-priority Recommendations to Facilitate Adoption of AHA Diet and Lifestyle Recommendations <ul><li>Groups included: Health Practitioners, Restaurants, Food Industry, Schools, Local Government </li></ul><ul><li>Specific Recommendations </li></ul><ul><ul><li>Food Industry </li></ul></ul><ul><ul><ul><li>Reduce salt and sugar content of processed foods </li></ul></ul></ul><ul><ul><ul><li>Replace saturated and trans fat in prepared foods with low-saturated fat oils </li></ul></ul></ul><ul><ul><ul><li>Increase proportion of whole grain foods available </li></ul></ul></ul><ul><ul><ul><li>Package foods in smaller portion sizes </li></ul></ul></ul><ul><ul><ul><li>Develop packaging that allows more stability, preservation and palatability of fresh fruits & vegetables without added sodium </li></ul></ul></ul>Adapted from Lichtenstein et al., Circulation, 114, 82-96, 2006
  24. 26. Practical Tips to Implement AHA Diet and Lifestyle Recommendations (Sodium Related) <ul><li>Food choices and preparation </li></ul><ul><ul><li>Use nutrition facts panel and ingredients list to choose food purchases </li></ul></ul><ul><li>Eat fresh, frozen and canned vegetables and fruits without high-calorie sauces, added salt and sugars </li></ul><ul><li>Reduce salt intake by: </li></ul><ul><ul><li>Comparing sodium content of products and choosing ones with less salt </li></ul></ul><ul><ul><li>Choosing reduced sodium versions or foods, including cereals and baked goods </li></ul></ul><ul><ul><li>Limiting condiments (eg. soy sauce, ketchup) </li></ul></ul><ul><li>Limit processed meat intake, especially those high in saturated fat and sodium </li></ul>Lichtenstein et al., Circulation, 114, 82-96, 2006
  25. 27. 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
  26. 28. 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)
  27. 29. Summary <ul><li>Current dietary guidance targets sodium reduction, and provides strategies for implementation </li></ul><ul><li>Given the widespread distribution of sodium in the food supply, there are many targets </li></ul><ul><li>The restaurant and food industry can play a key role in decreasing sodium and helping consumers adhere to dietary recommendations </li></ul>

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