Challenges in sodium intake reduction and meal consumption patterns among participants with metabolic syndrome in a dietary trial

Nutrition Journal

Yunsheng Ma⁴  Liang Zheng¹  Gin-Fei Olendzki⁴  Zhiying Zhang⁴  Hua Fang²  James Carmody⁴  Philip A Merriam⁴  Wenjun Li⁴  Annie L Culver⁴  Gioia M Persuitte³  Nicole M Wedick⁴  Barbara C Olendzki⁴  Jinsong Wang⁴ 

[1] Tongji University Medical School, Shanghai, China;Division of Biostatistics and Health Services Research, Department of Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA, USA;Division of Biostatistics and Health Services Research, Department of Quantitative Health Science, Clinical and Population Health Research Doctoral Program, University of Massachusetts Medical School, Worcester, MA, USA;Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA

关键词: Meal location;    Meal type;    Metabolic syndrome;    Diet;    Sodium;   

Others  :  801950
DOI  :  10.1186/1475-2891-12-163

 received in 2013-07-02, accepted in 2013-12-09,  发布年份 2013

【 摘 要 】

Background

Dietary guidelines suggest limiting daily sodium intake to <2,300 mg for the general population, and <1,500 mg/d for those with certain cardiovascular risk factors. Despite these recommendations, few Americans are able to achieve this goal. Identifying challenges in meeting these guidelines is integral for successful compliance. This analysis examined patterns and amount of daily sodium intake among participants with metabolic syndrome enrolled in a one-year dietary intervention study.

Methods

Two hundred forty participants with metabolic syndrome enrolled in a dietary intervention trial to lose weight and improve dietary quality. Three 24-hour dietary recalls were collected at each visit which provided meal patterns and nutrient data, including sodium intake. A secondary data analysis was conducted to examine sodium consumption patterns at baseline and at one-year study visits. Sodium consumption patterns over time were examined using linear mixed models.

Results

The percentage of meals reported eaten in the home at both baseline and one-year follow-up was approximately 69%. Follow-up for the one-year dietary intervention revealed that the participants who consumed sodium greater than 2,300 mg/d declined from 75% (at baseline) to 59%, and those that consumed higher than 1,500 mg/d declined from 96% (at baseline) to 85%. Average sodium intake decreased from 2,994 mg at baseline to 2,558 mg at one-year (P < 0.001), and the sodium potassium ratio also decreased from 1.211 to 1.047 (P < 0.001). Sodium intake per meal varied significantly by meal type, location, and weekday, with higher intake at dinner, in restaurants, and on weekends. At-home lunch and dinner sodium intake decreased (P < 0.05), while dinner sodium intake at restaurant/fast food chains increased from baseline to one-year (P < 0.05).

Conclusion

Sodium intake for the majority of participants exceeded the recommended dietary guidelines. Findings support actions that encourage low-sodium food preparation at home and encourage public health policies that decrease sodium in restaurants and prepared foods.

【 授权许可】

   
2013 Wang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, Rinfret S, Schiffrin EL, Eisenberg MJ: The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol 2010, 56:1113-1132.
• [2]Appel LJ, Frohlich ED, Hall JE, Pearson TA, Sacco RL, Seals DR, Sacks FM, Smith SC Jr, Vafiadis DK, Van Horn LV: The importance of population-wide sodium reduction as a means to prevent cardiovascular disease and stroke: a call to action from the American Heart Association. Circulation 2011, 123:1138-1143.
• [3]Bibbins-Domingo K, Chertow GM, Coxson PG, Moran A, Lightwood JM, Pletcher MJ, Goldman L: Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med 2010, 362:590-599.
• [4]Whelton PK, Appel LJ, Sacco RL, Anderson CA, Antman EM, Campbell N, Dunbar SB, Frohlich ED, Hall JE, Jessup M, et al.: Sodium, blood pressure, and cardiovascular disease: further evidence supporting the american heart association sodium reduction recommendations. Circulation 2012, 126:2880-2889.
• [5]Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ: Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ 2013, 346:f1326.
• [6]Strazzullo P, D’Elia L, Kandala NB, Cappuccio FP: Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ 2009, 339:b4567.
• [7]Palar K, Sturm R: Potential societal savings from reduced sodium consumption in the U.S. adult population. Am J Health Promot 2009, 24:49-57.
• [8]United States, Department of Health and Human Services, United States, Department of Agriculture, United States. Dietary Guidelines Advisory Committee: Dietary guidelines for Americans, 2010. 7th edn. Washington, D.C: G.P.O; 2010.
• [9]Centers for Disease Control and Prevention (CDC): Vital signs: food categories contributing the most to sodium consumption - United States, 2007–2008. MMWR Morb Mortal Wkly Rep 2012, 61:92-98.
• [10]Eddy DM, Schlessinger L, Heikes K: The metabolic syndrome and cardiovascular risk: implications for clinical practice. Int J Obes (Lond) 2008, 32(Suppl 2):S5-S10.
• [11]Mozumdar A, Liguori G: Persistent increase of prevalence of metabolic syndrome among U.S. adults: NHANES III to NHANES 1999–2006. Diabetes Care 2011, 34:216-219.
• [12]Ford ES, Li C, Zhao G: Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US. J Diabetes 2010, 2:180-193.
• [13]Ervin RB: Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003–2006. Natl Health Stat Report 2009, 13:1-7.
• [14]Rodrigues SL, Baldo MP, de Sa Cunha R, Andreao RV, Del Carmen Bisi Molina M, Goncalves CP, Dantas EM, Mill JG: Salt excretion in normotensive individuals with metabolic syndrome: a population-based study. Hypertens Res 2009, 32:906-910.
• [15]Chen J, Gu D, Huang J, Rao DC, Jaquish CE, Hixson JE, Chen CS, Chen J, Lu F, Hu D, et al.: Metabolic syndrome and salt sensitivity of blood pressure in non-diabetic people in China: a dietary intervention study. Lancet 2009, 373:829-835.
• [16]Sarno F, Jaime PC, Ferreira SR, Monteiro CA: Sodium intake and metabolic syndrome: a systematic review. Arq Bras Endocrinol Metabol 2009, 53:608-616.
• [17]Raisanen JP, Silaste ML, Kesaniemi YA, Ukkola O: Increased daily sodium intake is an independent dietary indicator of the metabolic syndrome in middle-aged subjects. Ann Med 2012, 44:627-634.
• [18]Merriam PA, Ma Y, Olendzki BC, Schneider KL, Li W, Ockene IS, Pagoto SL: Design and methods for testing a simple dietary message to improve weight loss and dietary quality. BMC Med Res Methodol 2009, 9:87. BioMed Central Full Text
• [19]Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, et al.: Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005, 112:2735-2752.
• [20]Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, Franklin B, Kris-Etherton P, Harris WS, American Heart Association Nutrition C, et al.: Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 2006, 114:82-96.
• [21]SF S: Maintaining a nutrient database in a changing marketplace: keeping pace with changing food products - A research perspective. J Food Comp and Anal 2001, 14:315-322.
• [22]Frison L, Pocock SJ: Repeated measures in clinical trials: analysis using mean summary statistics and its implications for design. Stat Med 1992, 11:1685-1704.
• [23]Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, et al.: Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation 2010, 121:586-613.
• [24]Cogswell ME, Zhang Z, Carriquiry AL, Gunn JP, Kuklina EV, Saydah SH, Yang Q, Moshfegh AJ: Sodium and potassium intakes among US adults: NHANES 2003–2008. Am J Clin Nutr 2012, 96:647-657.
• [25]Sodium intake among adults - United States 2005–2006 MMWR Morb Mortal Wkly Rep 2010, 59:746-749.
• [26]Karanja NM, Obarzanek EVA, Lin P-H, McCullough ML, Phillips KM, Swain JF, Champagne CM, Hoben KP: Descriptive characteristics of the dietary patterns used in the dietary approaches to stop hypertension Trial. J Am Diet Assoc 1999, 99:S19-S27.
• [27]Anderson CA, Appel LJ, Okuda N, Brown IJ, Chan Q, Zhao L, Ueshima H, Kesteloot H, Miura K, Curb JD, et al.: Dietary sources of sodium in China, Japan, the United Kingdom, and the United States, women and men aged 40 to 59 years: the INTERMAP study. J Am Diet Assoc 2010, 110:736-745.
• [28]Loria CM, Obarzanek E, Ernst ND: Choose and prepare foods with less salt: dietary advice for all Americans. J Nutr 2001, 131:536S-551S.
• [29]Leung C, Koehler HH, Hard MM: Mineral contents of selected pre-prepared food sampled in a hospital food service line. J Am Diet Assoc 1982, 80:530-536.
• [30]Campbell NR, Johnson JA, Campbell TS: Sodium consumption: an individual’s choice? Int J Hypertens 2012, 2012:860954.
• [31]Bruemmer B, Krieger J, Saelens BE, Chan N: Energy, saturated fat, and sodium were lower in entrees at chain restaurants at 18 months compared with 6 months following the implementation of mandatory menu labeling regulation in King County, Washington. J Acad Nutr Diet 2012, 112:1169-1176.
• [32]Henney JE, Taylor CL, Boon CS, Institute of Medicine (US) Committee on Strategies to Reduce Sodium Intake: Strategies to Reduce Sodium Intake in the United States. Washington DC: National Academy of Sciences Press; 2010.
• [33]Song Y, Liu S: Magnesium for cardiovascular health: time for intervention. Am J Clin Nutr 2012, 95:269-270.
• [34]He FJ, MacGregor GA: Reducing population salt intake worldwide: from evidence to implementation. Prog Cardiovasc Dis 2010, 52:363-382.
• [35]Appel LJ, Angell SY, Cobb LK, Limper HM, Nelson DE, Samet JM, Brownson RC: Population-wide sodium reduction: the bumpy road from evidence to policy. Ann Epidemiol 2012, 22:417-425.
• [36]Pietinen P, Valsta LM, Hirvonen T, Sinkko H: Labelling the salt content in foods: a useful tool in reducing sodium intake in Finland. Public Health Nutr 2008, 11:335-340.
• [37]Sacks G, Rayner M, Swinburn B: Impact of front-of-pack 'traffic-light’ nutrition labelling on consumer food purchases in the UK. Health Promot Int 2009, 24:344-352.
• [38]Espeland MA, Kumanyika S, Wilson AC, Reboussin DM, Easter L, Self M, Robertson J, Brown WM, McFarlane M: Statistical issues in analyzing 24-hour dietary recall and 24-hour urine collection data for sodium and potassium intakes. Am J Epidemiol 2001, 153:996-1006.
• [39]Institute of Medicine (U.S.). Panel on Dietary Reference Intakes for Electrolytes and Water: DRI, dietary reference intakes for water, potassium, sodium, chloride, and sulfate. Washington, D.C: National Academies Press; 2005.
• [40]Hebert JR, Ebbeling CB, Matthews CE, Hurley TG, Ma Y, Druker S, Clemow L: Systematic errors in middle-aged women’s estimates of energy intake: comparing three self-report measures to total energy expenditure from doubly labeled water. Ann Epidemiol 2002, 12:577-586.