Laurie Barclay, MD
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March 27, 2009 — In 2005 to 2006, the lower sodium recommendation made in 2005 by the US Department of Health and Human Services (HHS) and US Department of Agriculture (USDA) was applicable to 69.2% of US adults, according to the results of a study reported in the March 27 issue of the Morbidity and Mortality Weekly Report.
"In 2005–2006, an estimated 29% of U.S. adults had hypertension (i.e., high blood pressure), and another 28% had prehypertension," write C. Ayala, PhD, and colleagues from Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention (CDC). "Hypertension increases the risk for heart disease and stroke, the first and third leading causes of death in the United States. Greater consumption of sodium can increase the risk for hypertension."
In the United States in 2005 to 2006, the estimated average daily intake of sodium in people older than 2 years was 3436 mg, despite HHS/USDA recommendations in 2005 for lower sodium intake. In US adults, recommendations are for not more than 2300 mg/day of sodium (about 1 tsp of salt), or not more than 1500 mg/day of sodium for high-risk groups (persons with hypertension, middle-aged and older adults, and blacks).
On the basis of data from the National Health and Nutrition Examination Survey (NHANES) from 4 annual survey periods from 1999 to 2006, the CDC determined that in 2005 to 2006, the lower sodium recommendation was applicable to 69.2% of US adults (approximately 145.5 million persons). Three nonoverlapping populations were defined for the analysis: all adults older than 20 years with hypertension, all adults older than 40 years without hypertension, and blacks aged 20 to 39 years without hypertension. During the 4 NHANES study periods, the overall percentage of persons in these risk groups increased significantly.
"Consumers and health-care providers should be aware of the lower sodium recommendation, and health-care providers should inform their patients of the evidence linking greater sodium intake to higher blood pressure," the study authors write.
In an accompanying editorial note, public health actions are described that could lower sodium intake, such as reducing the sodium content of processed foods; promoting intake of fruits, vegetables, and other low-sodium foods; and making food labeling changes to provide more pertinent information regarding sodium.
Limitations of this study include that NHANES data were restricted to the noninstitutionalized population, excluding persons who reside in long-term care facilities or correctional facilities. If these groups were included, the percentage of the population for whom the recommended 1500 mg/day sodium limit is applicable would likely increase.
"The World Health Organization has set a global target for maximum intake of salt for adults at 5 g/day (i.e., 2,000 mg/day of sodium) or lower if specified by national targets, such as the recommendation in the United States," the editorial concludes. "Eleven countries in the European Union have agreed to reduce salt intake by 16% over the next 4 years. In the United States, Healthy People 2010 calls for increasing to 95% the proportion of adults with high blood pressure who are taking action (e.g., reducing sodium intake) to help control their blood pressure (objective 12-11)."
Morb Mortal Wkly Rep. 2009;58:281–283.
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