Receiving Advice from a Health Professional and Action Taken to Reduce Dietary Sodium Intake among Adults

Objective: Population reductions in sodium intake could prevent hypertension, and current guidelines recommend that clinicians advise patients to reduce intake. This study aimed to estimate the prevalence of taking action and receiving advice from a health professional to reduce sodium intake in 10 US jurisdictions, including the first-ever data in New York state and Guam. Design: weighted prevalence and 95% confidence intervals (CI) overall and by location, demographic group, health status, and receipt of provider advice using self-reported data from the 2017 Behavioral Risk Factor Surveillance System optional sodium module Setting: seven states, the District of Columbia, Puerto Rico, and Guam Participants: adults aged ≥18 years Results: Overall, 53.6% (CI: 52.7, 54.5) of adults reported taking action to reduce sodium intake, including 54.8% (CI: 52.8, 56.7) in New York and 61.2% (CI: 57.6, 64.7) in Guam. Prevalence varied by demographic and health characteristics and was higher among adults who reported having hypertension (72.5%; CI: 71.2, 73.7) vs. those who did not report having hypertension (43.9%; CI: 42.7, 45.0). Among those who reported receiving sodium reduction advice from a health professional, 82.6% (CI: 81.3, 83.9) reported action vs. 44.4% (CI: 43.4, 45.5) among those who did not receive advice. However, only 24.0% (CI: 23.3, 24.7) of adults reported receiving advice from a health professional to reduce sodium intake. Conclusions: The majority of adults report taking action to reduce sodium intake. Results highlight an opportunity to increase sodium reduction advice from health professionals during clinical visits to better align with existing guidelines.

Sodium intake, health implications, and the role of population-level strategies

Evidence to date suggests that high sodium intake affects health adversely, yet the role of a population-level strategy to reduce sodium intake is often contested. This review focuses on current available evidence on regional sodium intake levels, health implications of sodium intake, and population-level strategies implemented worldwide. The limitations in evidence, the difficulties in implementing population-wide strategies to reduce sodium intake, and the need for such strategies are critically reviewed. Evidence clearly shows that sodium has an adverse effect on blood pressure, cardiovascular disease, and mortality. However, whether reduced sodium intake benefits all individuals or only hypertensive individuals is still unclear. Methodological issues and publication bias in current evidence are other matters of concern in sodium-related research. While it is essential to continue working toward the World Health Organization’s target of 30% reduction in sodium intake, due consideration should be given to improving the quality of research, reducing bias in publications, and reviewing evidence more critically.

Mapping Dietary Sodium Reduction Policies and Initiatives in the Region of the Americas

Objectives To map existing country policies addressing population dietary sodium reduction in the Americas; to identify policy gaps in the region following what is outlined in the World Health Organization (WHO) “Best Buys” most cost-effective recommendations for the prevention and control of diet-related noncommunicable diseases (NCDs); and to discuss priorities for future work in the Region. Methods This study used mixed methods to analyze data from 34 countries. Data were collected through a structured review, of mostly national official sources, to identify current policies in place to reduce population sodium intake. Also, responses from the last Pan American Health Organization (PAHO) online Survey on National Initiatives for Sodium Reduction in the Americas were included. Finally, country profiles were prepared and sent to each country's Public Health Agency for validation and comments. Results Almost all countries (n = 23/34) had a recommendation to reduce salt intake included in policies related to NCDs. Only six countries had specific and comprehensive policies to reduce sodium intake, and only one of them was a National Law. Adoption of the WHO “Best Buys” in national policies included: reformulation of food products with voluntary (n = 9/34) and mandatory targets (n = 2/34); establishment of a supportive environment in public institutions (n = 14/34); and implementation of front-of-pack labelling (n = 5/34). Some countries have implemented regulations restricting marketing of foods high in sodium to children (n = 5/34); nutritional labelling that includes sodium content, either voluntary (n = 9/34) or mandatory (n = 10/34); and no country has yet implemented taxes on high sodium foods. Conclusions In recent years, there has been a significant advance in policies to reduce sodium intake in the Region of the Americas. However, this review identified that the level of implementation in practice is complex to assess and quite heterogeneous. Reducing sodium consumption is a cost-effective intervention that can save many lives, by preventing and reducing the burden of diet related NCD's. Therefore, a further call to action is needed for governments to accelerate efforts in order to meet the 2025 global target of a 30% relative reduction in mean population intake of sodium. Funding Sources Pan American Health Organization (PAHO/WHO).

Don't Take it With a Grain of Salt

Background: Currently, sodium consumption of Canadians (2760 mg/day) exceeds the 2300 mg/day tolerable upper level putting Canadians at risk for hypertension and cardiovascular disease. Voluntary sodium reformulation strategies have been implemented in Canada, the United Kingdom (UK), United States (US) to reduce sodium intake from processed foods. The potential for sodium reformulation to reduce sodium intake across socioeconomic position (SEP) is not well understood. The objective of this study was to evaluate the extent to which fully achieving sodium reformulation targets for processed foods outlined in the Canada, UK, US strategies would decrease population and social inequities in sodium intake in Canadian adults. Design: A cross-sectional study was conducted using the 2015 Canadian Community Health Survey–Nutrition (n=13,519 participants aged ≥19 years, 53% females). Foods from the 24-hour dietary recall were matched to each country’s sodium reduction categories and target sodium levels were applied. Multivariable linear regressions were used to estimate mean sodium intake for the population and across SEP indicators (educational attainment, household food security, and household income adequacy quintiles). Results: Achieving Canada’s targets would reduce average sodium intake by 228 mg/day (95%CI: 196,260) compared to baseline. UK’s sodium targets would achieve greater reductions, decreasing average sodium intake by 270 mg/day (95%CI: 242,299). The US sodium targets would increase average sodium intake by 98 mg/day (95%CI: 64,132). Achieving sodium reformulation targets resulted in greater reductions in sodium intake in men, and in lower SEP groups. For example, educational inequalities in sodium intake observed at baseline were reduced in men [Canada: (RD: 148 mg/day, 95%CI: -30,327); UK: (RD: 152 mg/day, 95%CI: -43,347)] and eliminated in women. Conclusion: Achieving targets outlined in Canada and UK’s voluntary sodium reformulation strategies would significantly reduce mean sodium intake in Canadians. This study demonstrated the potential for reducing social inequities in sodium intake and health.

Knowledge, Attitudes, and Behaviors Related to Sodium Intake and Reduction Among Adult Consumers in the United States

Purpose. To describe the prevalence and determinants of sodium-related knowledge, attitudes, and behaviors among U.S. adults Design. A cross-sectional survey was used. Setting. The study was set in the United States in 2012. Subjects. Participants were 6122 U.S. adults. Measures. Sodium-related knowledge, attitudes, and behaviors were measured. Analysis. Chi-squared tests were used to determine differences in sodium-related knowledge, attitude, and behaviors by respondent characteristics; multiple logistic regression was used to examine associations between selected respondent characteristics and health professional advice, reported action, or knowledge, attitudes, and behaviors (adjusted for all other respondent characteristics). Results. About three-fourths of respondents answered eating too much sodium is “somewhat” or “very” harmful to their health. Twenty-six percent reported receiving health professional advice, and 45% reported taking action to reduce their sodium intake. The prevalence of reported action was highest among adults receiving advice, those with hypertension, blacks, and those aged ≥65 years. Sixty-two percent who reported action agreed that most of their sodium comes from processed or restaurant foods. Of those reporting action, the most common tactics to reduce sodium intake were checking nutrition labels, using other spices than salt, and choosing low-sodium foods; requesting lower-sodium options when eating out was the least common tactic. Conclusion. Results suggest almost half of adults overall and the vast majority of those receiving health professional advice are taking some action to watch or reduce sodium intake. Although a substantial proportion report using recommended tactics to lower intake, many are not using the most effective tactics. In order to reach the general population, health communication messages could be simpler and focus on the most effective tactics to reduce sodium intake. Furthermore, health professionals can help reduce sodium intake by discussing the benefits of sodium reduction and tactics to do so, regardless of a hypertension diagnosis.

Consumer Knowledge, Attitudes, and Behaviors of Sodium Intake and Reduction Strategies in Los Angeles County

Background and Purpose: In Los Angeles County, over 27% of the population has been diagnosed with hypertension and over 60% is considered overweight or obese. To help address the burden of hypertension and other diet-associated diseases, the Los Angeles County Department of Public Health launched its sodium reduction initiative to scale sodium reduction approaches and, ultimately, reduce sodium intake in the region. The purpose of this study was to gain a better understanding of consumer knowledge, attitudes, and behaviors related to sodium consumption and reduction to inform ongoing program efforts. Methods: A cross-sectional Internet panel survey was administered from December 2014 to January 2015 to a panel of Los Angeles County adult residents (n=848). Results: Results suggest low levels of consumer knowledge of recommended daily sodium intake limits (5.9%), high levels of support for reduction of sodium in the food supply (>70%), and moderate levels of healthy behavior change (e.g., 48.1% reported determining their food purchases based on the sodium content, 56.3% reported watching their sodium intake). Conclusions: These findings support the continued need to work at multiple levels (consumer, food supplier/manufacturer, retail) to reduce sodium intake in Los Angeles County.